Perivascular mesenchymal precursor cell induced blood vessel formation

ABSTRACT

Mesenchymal precursors cells have been isolated from perivascular niches from a range of tissues utilizing a perivascular marker. A new mesenchymal precursor cell phenotype is described characterized by the presence of the perivascular marker 3G5, and preferably also alpha smooth muscle actin together with early developmental markers such as STRO-1 and CD146/MUC18. The perivascular mesenchymal precursor cell is shown to induce neovascularization and improvement in cardiac function. Suitable administration of preparations of the mesenchymal precursor cells are useful for treatment of cardiovascular diseases, cerebrovascular diseases and peripheral vascular diseases.

This application is a divisional of U.S. Ser. No. 10/551,326, which is a§371 National Stage of PCT International Application No.PCT/AU2004/000417, filed Mar. 29, 2004, which claims priority ofAustralian Provisional Application No. 2003901668, filed Mar. 28, 2003,the contents of all of which are hereby incorporated by reference.

FIELD OF THE INVENTION

This invention relates to mesenchymal precursor cells that carry aperivascular marker and are able to induced blood vessel formation, to acomposition comprising such precursor cells and a method of inducingblood vessels. The invention also relates to treatment of cardiovascularconditions in particular ischemia.

BACKGROUND OF THE INVENTION

Vascular conditions constitute a major health problem, particularly inwestern countries. Vascular conditions include heart conditions,peripheral vascular disease and cerebrospinal vascular conditions.

A major proportion of these conditions result from a lack of supply ofblood to the respective tissues which thus are either chronically oracutely deprived of necessary levels of oxygen and nutrients. Typicallythese conditions result in ischemias where there has been blockage ofthe blood vessel by build up of, for example, plaque or physical bloodvessel damage such that these are either blocked or constricted.

Heart conditions are perceived as the most prominent vascular disease.About 11 million adults in the United States of America (1995) hadcoronary heart disease, that however is out of a total of about 60million adults with cardiovascular disease. Other vascular conditionsthus affect a greater number of adults.

A relatively common cerebrovascular condition can manifest as a stroke,where an occlusion can lead to an acute attack. A gradual diminution ofsupply may also lead to decreased capacity of the brain to function andit has been postulated that such conditions may be associated with theonset of certain dementias.

Peripheral vascular disease are associated with a number of conditions,for example, as a complication of diabetes where a typical inadequacy ofthe microcirculation depletes supply to the extremities particularly thefeet and legs of oxygen and nutrients.

Another example of reduced localized supply can occur with the treatmentof various wounds including severe burns or chronic wounds such as bedsores. Chronic wounds are difficult to heal, partly due to aninsufficient vascular bed supply of nutrient and healing compounds.

Scar formation may also be exacerbated because the healing process ofteninvolves a highly fibrotic tissue forming within minimal blood vesselformation. Scar formation is also a difficulty associated with achievingan adequate vascular supply in circumstances where a prosthesis or otherimplant is surgically position in a human tissue. An inadequate bloodsupply to the interface between the implant and the surrounding tissuecan lead to medical complications and necrosis. This is of far morenoticeable relevance where the implant is intended as a long term slowrelease depot of for example a pharmaceutical.

Treatment of myocardial ischemias are probably the most advanced ofcurrent treatments of vascular conditions. Present treatments includepharmacological therapies, coronary artery bypass surgery andpercutaneous revascularization using techniques such as balloonangioplasty. Standard pharmacological therapy to aims either increaseblood supply to the heart muscle or decreasing the demand of the heartmuscle for oxygen and nutrients. Increased blood supply to themyocardium by relaxation of smooth muscle is achieved by administeringagents such as calcium channel blockers or nitroglycerin. Decreaseddemand of the heart muscle for oxygen and nutrients is accomplishedeither by agents that decrease the hemodynamic load on the heart, suchas arterial vasodilators, or those that decrease the contractileresponse of the heart to a given hemodynamic load, such as β-adrenergicreceptor antagonists. Surgical treatment of ischemic heart disease isbased on the bypass of diseased arterial segments with strategicallyplaced bypass grafts. Percutaneous neovascularization is based on theuse of catheters to reduce the narrowing in diseased coronary arteries.All of these strategies are used to decrease the number of, or toeradicate, ischemic episodes, but all have various limitations, andparticularly the pharmaceutical approach can have severe side effects.

Preliminary reports describe new vessel development in the heart throughthe direct injection of angiogenic proteins or peptides. The severalmembers of the fibroblast growth factor (FGF) family (namely acidicfibroblast growth factor, aFGF; basic fibroblast growth factor, bFGF;fibroblast growth factor-5, FGF-5 and others) have been implicated inthe regulation of angiogenesis during growth and development. Genetherapy has been suggested by Hammond et al in U.S. Pat. No. 5,792,453as a delivery mechanism for these angiogenic compounds.

Another suggested approach to promoting new blood vessel formation fortreatment of vascular conditions is the administration of stem cellswhich can differentiate and give rise to cells required for such bloodvessels to form. One problem associated with this approach is that it isnot entirely clear which progenitor cells are responsible for formationof blood vessel or whether indeed more than one cell type is required orwhether other angiogenesis promoters are required.

One reported approach described in U.S. Pat. No. 5,980,887 (to Isner etal) has resulted from the isolation of an endothelial progenitor celland the discovery that such cells play a role in blood vessel formation.

Numerous attempts at isolating and enriching mesenchymal precursor cellshave been made because of the potential that these cells have formedicinal use. Pittinger et al., (1999) show the expansion of clonogeniccells from bone marrow and describes a preparation of enlargedmesenchymal stem cells. A more recent example of such a method providingfor a relatively high yield from bone marrow is disclosed in publicationWO01/04268 to Simmons et al. Neither of these reported mesenchymal cellswere indicated as being capable of regeneration vascular lineages ofcells capable of leading to blood vessel formation.

To date however there have been no examples of isolated mesenchymalprecursor cells capable of forming vascular tissues in vivo.

SUMMARY OF THE INVENTION

The present invention arises from the finding that a population ofmesenchymal precursor cells (MPCs) is present in a perivascular niche.This has led to the demonstration that there is a much wider range oftissue type sources of MPCs than the single tissue, bone marrow,referred to in WO01/04268. The present invention arises from theadditional finding that an enriched population MPCs can bedifferentiated into two populations discriminated by the marker 3G5.MPCs that are 3G5 positive are considered of interest particularly forneovascularization applications, although demonstrably they are alsoable to differentiate into other tissue types. It is an additionalfinding of the present invention that levels of MPCs present inpreferred enriched populations of this invention are able to give riseto sufficient numbers of committed cells to provide a number ofdifferentiated tissue types. It is an additional finding of the presentinvention that certain levels of MPCs are useful on introduction into apatient to provide a measurable vascularisation benefit. It has thusspecifically been found that a level of an estimated about 10⁵ MPCs aresufficient to provide a measurable benefit of cardiac improvement in anischemic rat myocardium. This then provides a datum from which anassessment can be made about the numbers of MPCs required to provide abeneficial effect. This is also believed to be the first time that acardiac benefit has been shown on administration of a mesenchymalprecursor cell to the heart.

In a first form of a first aspect the invention might be said to residein a method of inducing the formation or repair of blood vessels in atarget tissue of a patient, the method comprising the steps ofadministering to said patient an effective amount of a population ofenriched perivascular mesenchymal precursor cells (MPCs) to induce newblood vessel formation in target tissue.

In a first form of a second aspect the invention might be said to residein a method of repairing damaged tissue in a human subject in need ofsuch repair, the method comprising:

(a) obtaining an enriched population of MPC, and

(b) contacting an effective amount of the enriched population of MPCwith the damaged tissue of said subject

In a first form of a third aspect the invention might be said to residein a method of repairing damaged tissue in a human subject in need ofsuch repair, the method comprising:

(a) expanding the enriched MPC of claim 41 in culture, and

(b) contacting an effective amount of the expanded cells with thedamaged tissue of said subject.

In a first form of a fourth aspect the invention might be said to residein a method of inducing formation or repair of blood vessels, the methodcomprising the steps of providing a population of enriched perivascularmesenchymal precursor cells (MPCs), contacting said cells with a growthmedia, and culturing said cells under conditions to induce them todifferentiate into new blood vessels.

In a first form of a fifth aspect the invention might be said to residein a composition for use in inducing heart vessel formation comprising apopulation of mesenchymal precursor cells (MCPs) in a pharmaceuticallyacceptable carrier, said MPCs carrying a perivascular marker and being avascular progenitor.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1. Properties of STRO-1⁺ MACS-isolated cells co-labeled withanti-CD146 (CC9). (A) Sort region, R1, represents the double positiveSTRO-1^(BRT)/CD146⁺ population. (B) The incidence of clonogenic cellcolonies (>50 cells) based on STRO-1^(BRT)/CD146⁺ expression wasdetermined by limiting dilution analysis of 24 replicates per cellconcentration using Poisson distribution analysis from 5 independentexperiments. Forward (size) and perpendicular (granularity) lightscatter characteristics of BMMNCs (C), STRO-1^(int)/CD146⁻ cells (D) andSTRO-1^(BRT)/CD146⁺ cells (E). (F) RT-PCR analysis ofSTRO-1^(BRT)/CD146⁺ sorted marrow cells for CBFA1 (lane 2), osteocalcin(lane 4) and GAPDH (lane 6) transcripts. Control cells (BMSSC culturesgrown in the presence of dexamethasone) expressing CBFA1 (lane 1),osteocalcin (lane 3), and GAPDH (lane 5) is also shown. Reaction mixeswere subjected to electrophoresis on a 1.5% agarose gel and visualisedby ethidium bromide staining. (G) In situ expression of CD146 on bloodvessel (bv) walls (arrow) in human bone marrow (bm) sections near thebone (b) surface 20X. Sections were counter stained with Hematoxylin.(H) Dual Immunofluorescence staining demonstrating reactivity of theSTRO-1 antibody labeled with Texas red and the CC9 antibody labeled withfluorescein isothiocyanate, reacting to blood vessel walls in frozensections of human bone marrow.

FIG. 2. Immunophenotypic analysis of DPSCs in vivo. The bar graphdepicts the number of clonogenic colonies retrieved from single cellsuspensions of dental pulp following immunomagnetic bead selection basedon reactivity to antibodies that recognize STRO-1, CD146, and 3G5 andisotype-matched negative control antibodies. The data are expressed asthe number of colony-forming units obtained in the bead positive cellfractions as a percentage of the total number of colonies inunfractionated pulp cells averaged from three separate experiments.Statistical significance (*) was determined using the student t-test (p0.01) comparing the percent total number of colonies for each antibodywith the corresponding isotype-matched control.

FIG. 3. Reactivity of perivascular makers in dental pulp. (A)Immunolocalization of the STRO-1 antigen on blood vessels (small arrows)in human dental pulp (p) and around perineurium (large arrow)surrounding a nerve bundle (nb) 20X. (B) Dual Immunofluorescencestaining demonstrating reactivity of the STRO-1 antibody labeled withTexas Red to dental pulp perineurium (arrow) in combination with ananti-neurofilament antibody labeled with fluorescein isothiocyanatestaining the inner nerve bundle (nb), 40X. (C) Immunolocalization of theCD146 antigen to blood vessel walls in human dental pulp tissue 20X. (D)Dual Immunofluorescence staining demonstrating reactivity of the STRO-1antibody labeled with Texas red to a blood vessel and the CC9 antibodylabeled with fluorescein isothiocyanate. (E) Immunohistochemicalstaining of pulp tissue with a rabbit polyclonal anti-DSP antibody(arrow) to the odontoblast outer layer (od). 20X. (F) 3G5 reactivity toa single pericyte (arrow) in a blood vessel (bv) wall 40X. Tissuesections were counter stained with Hematoxylin.

FIG. 4. 3G5 reactivity to BMSSCs. (A) The representative histogramdepicts a typical dual-color FACS analysis profile of whole bone marrowmononuclear cells (BMMNCs) expressing CD146 (PE) and 3G5 (FITC). (B)Colony efficiency assays were performed for all the different expressionpatterns observed (regions “R” 1-6). The data are expressed as the meanincidence of colony-forming units for each cell fraction averaged fromthree separate experiments.

FIG. 5. Developmental potential of purified BMSSCs and DPSCs in vivo.Cytospin preparations of MACS/FACS isolated STRO-1^(BRT)/CD146⁺ marrowcells (arrow) stained with an antibody specific to α-smooth muscle actin(A) and von Willebrand Factor (B). CD146⁺ pulp cells (large arrow)isolated by immunomagnetic bead selection (magnetic beads depicted bysmall arrows), stained with an antibody specific to α-smooth muscleactin (C) and von Willebrand Factor. (D). (E) Ectopic bone formation (b)and haematopoietic/adipogenic marrow (bm) by ex vivo expanded cellsderived from STRO-1^(BRT)/CD146⁺ BMSSCs transplanted with HA/TCP intoimmunocompromised mice for three months (E). (F) Ectopic formation ofdentin (d) and fibrous pulp tissue (p) by ex vivo expanded cells derivedfrom CD146⁺ DPSCs transplanted with HA/TCP into immunocompromised micefor three months. Sections were stained with Hematoxylin & Eosin.

FIG. 6 Expression of CD34, CD45 and Glycophorin-A on STRO-1 positivebone marrow mononuclear cells. Representative histograms depictingtypical dual-colour flow cytometric analysis profiles of STRO-1 positivebone marrow mononuclear cells isolated initially by magnetic activatedsorting and co-stained with antibodies directed against CD34 (A), CD45(3) or Glycophorin-A (C). The STRO-1 antibody was identified using agoat anti-murine IgM-fluorescein isothiocyanate while CD34, CD45 andGlycophorin-A were identified using a goat anti-murineIgG-phycoerythrin. The high expressing STRO-1 fraction which containedthe clonogenic MPC population was isolated by fluorescence activatedcell sorting based on regions R1 and R2.

FIG. 7 Bone marrow MPC are STRO-1 bright, CD34 negative, CD45 negativeand Glycophorin-A negative. The graph depicts the results of in vitroadherent colony formation assays performed for each of the differentsorted STRO-1 bright populations selected by their co-expression or lackof either the CD34, CD45 or Gycophorin-A antigens, based on regions R1and R2 as indicated in FIG. 6. These data are expressed as the meanincidence of colony-forming units for each cell fraction averaged fromtwo separate experiments.

FIG. 8A-8D Reactivity of perivascular makers in different human tissues.Dual-colour immunofluorescence staining demonstrating reactivity of (A)STRO-1 and CD146, (B) STRO-1 and alpha-smooth muscle actin, and (C) 3G5and CD146, on blood vessels and connective tissue present on spleen,pancreas (Panel 1), brain, kidney (Panel 2), liver, heart (Panel 3) andskin (Panel 4) 20.times. The STRO-1 and 305 antibodies were identifiedusing a goat anti-murine IgM-Texas Red while CD146 and alpha-smoothmuscle actin were identified using a goat anti-murine or IgG-fluoresceinisothiocyanate. Co-localization is indicated by overlapping areas ofyellow and orange fluorescence (white arrows).

FIG. 9 Isolation of adipose-derived MPC by FACS. Representative flowcytometirc histograms depicting the expression of STRO-1, CD146 and 3G5in fresh preparations of peripheral adipose-derived single-cellsuspensions generated following collagenase/dispase digestion aspreviously described (Shi and Gronthos 2003). The antibodies wereidentified using either a goat anti-murine IgM or IgG-phycoerythrin.Cell populations were then selected by FACS, based on their positivity(region R3) or negativity (region R2) to each marker and then platedinto regular growth medium to assess the incidence of adherentcolony-forming cells in each cell fraction.

FIG. 10 Clonogenic adipose-derived MPC are positive forSTRO-1/3G5/CD146. The bar graph depicts the number of clonogeniccolonies retrieved from single cell suspensions of enzymaticallydigested human peripheral adipose tissue, following fluorescenceactivated cell sorting, based on their reactivity to antibodies thatrecognize STRO-1, CD146, and 3G5 (FIG. 9), then cultured in standardgrowth medium as previously described for bone marrow and dental pulptissue (Shi and Gronthos 2003). The data are expressed as the number ofcolony-forming units obtained per 10⁵ cells plated in the positive andnegative cell fractions averaged from two separate experiments.

FIG. 11 Immunophenotypic analysis of adipose-derived MPC Representativeflow cytometric histograms depicting the co-expression of STRO-1 andCD146 (A) and 3G5 and CD146 in fresh preparations of peripheraladipose-derived single-cell suspensions generated followingcollagenase/dispase digestion. The STRO-1 and 3G5 antibodies wereidentified using a goat anti-murine IgM-phycoerythrin while CD146 wasidentified using a goat anti-murine IgG-fluorescein isothiocyanate.

FIG. 12 Developmental potential of purified Adipocyte-derived MPC invitro. Preparations of primary MPC cultures derived from STRO-1⁺/CD146⁺adipose cells were re-cultured either in standard culture conditions(A), osteogenic inductive medium (B), Adipogenic inductive medium (C) orchondrogenic conditions (D) as previously described Gronthos et al.2003. Following two weeks of multi-differentiation induction, theadipocyte-derived MPC demonstrated the capacity to form bone (B;Alizarin positive mineral deposits), fat (C; Oil Red O positive lipid)and cartilage (D: collagen type II matrix).

FIG. 13 Isolation of skin-derived MPC by FACS. Representative flowcytometirc histograms depicting the expression of STRO-1, CD146 and 3G5in fresh preparations of full thickness skin-derived single-cellsuspensions generated following collagenase/dispase digestion. Theantibodies were identified using either a goat anti-murine IgM orIgG-phycoerythrin. Cell populations were then selected by FACS, based ontheir positivity (region R3) or negativity (region R2) to each markerand then plated into regular growth medium to assess the incidence ofadherent colony-forming cells in each cell fraction.

FIG. 14 Clonogenic skin-derived MPC are positive for STRO-1/3G5/CD146.The bar graph depicts the number of adherent colonies recovered fromsingle cell suspensions of enzymatically digested human skin, followingfluorescence activated cell sorting, based on their reactivity toantibodies that recognize STRO-1, CD146, and 3G5 (FIG. 6), then culturedin standard growth medium as previously described for bone marrow anddental pulp tissue (Shi and Gronthos 2003). The data are expressed asthe number of colony-forming units obtained per 10⁵ cells plated in thepositive and negative cell fractions averaged from two separateexperiments.

FIG. 15 Prominent in vivo survival of cultured STRO1^(bright) cellsadjacent to blood vessels.

FIG. 16 Tumour arteriogenesis induced by cultured STRO1^(bright) cells

FIG. 17 Tumor arteriogenesis induced by progeny of STRO1^(bright) cells

FIG. 18 Dose-dependent cardiac arteriogenesis by cultured STRO1^(bright)cells.

FIG. 19 Improvement in left ventricular ejection fraction (EF) bymyocardial injection of cultured STRO1^(bright) cells.

FIG. 20 Improvement in left ventricular fractional area shortening (PAS)by myocardial injection of cultured STRO1^(bright) cells.

FIG. 21 Improvement in global cardiac function by myocardial injectionof cultured STRO1^(bright) cells.

FIG. 22. Ex vivo expanded STRO-1^(bri) MPC can develop into arteriolesin vitro. Single cell suspensions of ex vivo expanded bone marrowSTRO-1^(bri) MPC were prepared by trypsin/EDTA treatment then platedinto 48-well plates containing 200 μl of matrigel. The STRO-1^(bri) MPCwere plated at 20,000 cells per well in serum-free medium (Gronthos etal. 2003) supplemented with the growth factors PDGF, EGF, VEGF at 10ng/ml. Following 24 hours of culture at 37° C. in 5% CO₂, the wells werewashed then fixed with 4% paraformaldehyde. Immunohistochemical studieswere subsequently performed demonstrated that the cord-like structuresexpressed alpha-smooth muscle actin identified with a goat-anti-murineIgG horse radish peroxidase antibody.

FIG. 23 A. Immunophenotypic expression pattern of ex vivo expanded bonemarrow MPC. Single cell suspensions of ex vivo expanded bone marrow MPCwere prepared by trypsin/EDTA treatment then incubated with antibodiesidentifying cell lineage-associated markers. For those antibodiesidentifying intracellular antigens, cell preparations were fixed withcold 70% ethanol to permeabilize the cellular membrane prior to stainingfor intracellular markers. Isotype matched control antibodies weretreated under identical conditions. Flow cytometric analysis wasperformed using a COULTER EPICS instrument. The dot plots represent5,000 listmode events indicating the level of fluorescence intensity foreach lineage cell marker (bold line) with reference to the isotypematched negative control antibodies (thin line).

FIG. 23 B. Gene expression profile of cultured MPC. Single cellsuspensions of ex vivo expanded bone marrow MPC were prepared bytrypsin/EDTA treatment and total cellular RNA was prepared. UsingRNAzolB extraction method total RNA was isolated and used as a templatefor cDNA synthesis, prepared using standard procedure. The expression ofvarious transcripts was assessed by PCR amplification, using a standardprotocol as described previously (Gronthos et al. 2003). Primers setsused in this study are shown in Table 2. Following amplification, eachreaction mixture was analysed by 1.5% agarose gel electrophoresis, andvisualised by ethidium bromide staining. Relative gene expression foreach cell marker was assessed with reference to the expression of thehouse-keeping gene, GAPDH, using ImageQuant software.

DETAILED DESCRIPTION OF THE ILLUSTRATED AND EXEMPLIFIED EMBODIMENTS OFTHE INVENTION

The invention resides in a method of inducing neovascularisation by useof a composition of precursor cells. This has a range of application.

The invention thus has application in inducing blood vessel repair orformation, for example in the treatment of cerebrovascular ischemia,renal ischemia, pulmonary ischemia, limb ischemia, ischemiccardiomyopathy and myocardial ischemia, endothelial progenitor cells areadministered.

A wide range of tissues might be treated and such tissues can include,for example, muscle, brain, kidney and lung. Ischemic diseases include,for example, cerebrovascular ischemia, renal ischemia, pulmonaryischemia, limb ischemia, ischemic cardiomyopathy and myocardialischemia.

The treatment of these conditions might include the step of isolatingmesenchymal progenitor cells from a tissue of the patient, and thenreadministering them to the patient. The patient may also be treatedwith compound known to promote formation or repair of blood vessels orto enhance mesenchymal cell growth and/or vascular differentiation. Forthis purpose the MPCs may be administered to the patient by any suitablemeans, including, for example, intravensou infusion, bolus injection,and site directed delivery via a catheter.

The invention may also have applicability for the treatment of burns andwounds, including chronic sores such as bed sores, and certainulcerations. For these conditions the MPCs might be applied topically,perhaps suspended in a cream or together with a suitable agent to assistwith migration of the cells into the subsurface. Alternatively the MPCsmight be held within a bandage perhaps within a protective matrix thatis soluble on prolonged contact with the wound or other surface.

The invention may also have application where a reduced blood supplyleads to for example baldness. The composition of MPCs may in injectedsubcutaneously or dermally in the affected area.

In vitro grown grafts of vascularised tissue are also contemplated bythe invention whereby MPCs are grown in media and in the presence ofcompounds known to promote differentiation into vascular cells, toproduce a graft which includes undifferentiation, partiallydifferentiated and some differentiated cells.

In the case of an implant the surgeon may apply a composition containingthe MPCs during the implantation a prosthesis, to promotevascularisation at the interface of the prosthesis and the surroundingtissue. An alternative process may be to have MPCs or a partially orfully differentiated graft developed on the implant. This may or may notbe held within a protective matrix. The benefit of a graft is thatvascularisation, and thus the healing process may be speeded up.

Blood vessels are an ideal position from which to delivery a medicinalproduct. The discovery of these MPCs and their properties of forming newblood vessels provides an opportunity to delivery over an extendedperiod medicinal products.

The MPCs may be modified to carry various genetic material. The geneticmaterial may be those that encode a variety of proteins includinganticancer agents, hormones such as for example insulin, growth factorsenzymes cytokines, and the like.

Alternatively the MPCs might be modified to express a blood vesselformation promoter which might assist in the MPCs induction of bloodvessel formation, and assisting further with the maintenance of a goodvascularisation of the tissue concerned.

For purposes of treating a cardiac vascular disease MPCs may bedelivered to the myocardium by direct intracoronary (or graft vessel)injection using standard percutaneous catheter based methods underfluoroscopic guidance, at an amount sufficient for effective therapy.This may be in the range of between 10⁴ to 10⁷ MPCs. The injectionshould be made deeply into the lumen (about 1 cm within the arteriallumen) of the coronary arteries (or graft vessel), and preferably bemade in both coronary arteries. By injecting the material directly intothe lumen of the coronary artery by coronary catheters, it is possibleto target MPC rather effectively, and to minimize loss during injection.Any variety of coronary catheter perfusion catheter can be used.

For the treatment of peripheral vascular disease, a diseasecharacterized by insufficient blood supply to the legs an MPC maydelivered by a catheter that will be inserted into the proximal portionof the femoral artery or arteries, thereby effecting migration of theMPCs to the capillaries of the skeletal muscles receiving blood flowfrom the femoral arteries. This will provide an angiogenic stimulus thatwill result in neovascularisation andor repair of blood vessels inskeletal muscle of the legs.

Compositions or products of the invention for use with coronary orperipheral vascular disease may conveniently be provided in the form offormulations suitable for intracoronary administration. A suitableadministration format may best be determined by a medical practitionerfor each patient individually. Suitable pharmaceutically acceptablecarriers and their formulation are described in standard formulationstreatises, e.g., Remington's Pharmaceuticals Sciences by E. W. Martin.Compositions may be formulated in solution at neutral pH, for example,about pH 6.5 to about pH 8.5, more preferably from about pH 7 to 8, withan excipient to bring the solution to about isotonicity, for example,4.5% mannitol or 0.9% sodium chloride, pH buffered with art-known buffersolutions, such as sodium phosphate, that are generally regarded assafe. The desired isotonicity may be accomplished using sodium chlorideor other pharmaceutically acceptable agents such as dextrose, boricacid, sodium tartrate, propylene glycol, polyols (such as mannitol andsorbitol), or other inorganic or organic solutes. Sodium chloride ispreferred particularly for buffers containing sodium ions. If desired,solutions of the above compositions may also be prepared to enhanceshelf life and stability. The therapeutically useful compositions of theinvention are prepared by mixing the ingredients following generallyaccepted procedures. For example, the selected components may be mixedto produce a concentrated mixture which may then be adjusted to thefinal concentration and viscosity by the addition of water and/or abuffer to control pH or an additional solute to control tonicity.

For use by the physician, the compositions will be provided in dosageform containing an amount of MPC composition which will be effective inone or multiple doses to induce angiogenesis at a selected level. Aswill be recognized by those in the field, an effective amount oftherapeutic agent will vary with many factors including the age andweight of the patient, the patients physical condition, and the level ofangiogenesis to be obtained, and other factors.

The effective does of the compounds of this invention will typically bein the range of at least about 10⁴ MPCs, preferably about 10⁶ MPCs, andmore preferably about 10⁷ MPCs. As noted, the exact dose to beadministered is determined by the attending clinician, but is preferablyin 1 ml phosphate buffered saline.

The presently preferred mode of administration in the case of heartdisease is by intracoronary injection to one or both coronary arteries(or to one or more saphenous vein or internal mammary artery grafts)using an appropriate coronary catheter. The presently preferred mode ofadministration in the case of peripheral vascular disease is byinjection into the proximal portion of the femoral artery or arteriesusing an appropriate arterial catheter.

Preferably the MPCs are coadministered with a blood vessel promotingcompound. These might include acidic and basic fibroblast growthfactors, vascular endothelial growth factor, epidermal growth factor,transforming growth factor α and β, platelet-derived endothelial growthfactor, platelet-derived growth factor, tumor necrosis factor α,hepatocyte growth factor, insulin like growth factor, erythropoietin,colony stimulating factor, macrophage-CSF, GM-CSF and nitricoxidesynthase.

To further enhance angiogenesis an endothelial progenitor cell modifiedto express an endothelial cell mitogen may be used. Additionally, anperivascular cell mitogen or a nucleic acid encoding an perivascularcell mitogen can further be administered.

The MPCs might also be injected intramuscularly adjacent a site of thedamaged blood vessel.

Composition might include a topical application for wounds and thus maybe incorporated into creams lotions and the like.

The MPCs can be delivered in a composition that takes the form of aninjectable preparation containing pharmaceutically acceptable carriersuch as saline, for example, as necessary. The preparation may requiresterilisation and may include stabiliser to maintain a uniformdistribution of cells. The final dose of MPCs is preferably in the rangeof about 10⁴-10⁷ cells.

The present invention relates to mesenchymal precursor cells, inparticular those that may be present in the perivascular compartment ofvascularised tissue. Such mesenchymal cells may be identified by thepresence of the 3G5 surface marker, and perhaps additionally orseparately by other early developmental markers such as CD146 (MUC18),VCAM-1 and STRO-1.

Precursor cells are early cells that are substantially at apre-expansion stage of development. These are cells that have yet todifferentiate to fully committed cells, however they need not be stemcells in a strict sense, in that they are necessarily able todifferentiate into all types of cells. Partially differentiatedprecursor cells have a benefit in that they have a greater proliferativepotential than stem cells.

The present precursor cells are somewhat differentiated in that they arecommitted to mesenchymal tissue, as opposed, for example, tohaemopoietic tissues. It is evident from the data produced that the MPCsthat have been isolated lack markers associated with haemopoietic cellssuch as CD34, and additionally their differentiation potential does notextend to haemopoietic lines. Additionally they need not necessarilyhave the potential to differentiate into all mesenchymal cell type,rather, they may be able to differentiate into one, two three or morecell types.

It is anticipated that these precursor cell harvested from the tissuesconcerned may be useful for regenerating tissue for cells types fromwhich they have been sourced. Thus precursor cells isolated from heartmay be reintroduced to regenerate heart tissue, however their potentialneed not be so limited, precursor cells isolated from one tissue typemight be useful for regenerating tissue in another tissue type. Themicroenvironment in which an undifferentiated cell finds itself is knownto exert an influence on the route of differentiation and therefore thereintroduction need not necessarily be tissue specific.

The data presented show that MPCs have been harvested and thenre-introduced to produce bone and bone marrow and dentin and pulprespectively, in addition arterioles, cord like structures, have beenproduced after ex vivo expansion of isolated MPCs.

It is anticipated that a wide range of cells might be produced based ongene expression of markers characteristic for certain cell types. It isthus anticipated that under appropriate culture conditions the range ofcell types that can be generated from the perivascular MPCs of thepresent invention include but are not limited to the following,osteoblast, odontoblast, dentin-producing, chondrocyte, tendon,ligament, cartilage, adipocyte, fibroblast, marrow stroma, osteoclast-and hematopoietic-supportive stroma, cardiac muscle, smooth muscle,skeletal muscle, pericyte, vascular, epithelial, glial, neuronal,astrocyte or oligodendrocyte cell.

One of the benefits of the finding that MPCs can be isolated fromperivascular cells is that this greatly expands the range of sourcetissues from which MPCs can be isolated or enriched and there is nolonger an effective restriction on the source of MPCs to bone marrow.The tissues from which these MPCs have been isolated in theexemplifications of this invention are human bone marrow, dental pulpcells, adipose tissue and skin. In addition in situ staining andhistological studies have identified that MPC are present in theperivascular compartment of spleen, pancreas, brain, kidney, liver andheart. Given this wide and diverse range of tissue types whereperivascular MPCs are present, it is proposed that MPC will also bepresent from an even wider range of tissue which may include, adiposetissue, teeth, dental pulp, skin, liver, kidney, heart, retina, brain,hair follicles, intestine, lung, spleen, lymph node, thymus, pancreas,bone, ligament, bone marrow, tendon, and skeletal muscle.

These precursor cells of the present invention are distinguished fromother known MPCs in that they are positive for 3 G5 or perhaps that theycarry another perivascular markers. They can be isolated by enrichingfor an early developmental surface marker present on perivascular cells,in particular the presence of one or more of CD146(MUC18), VCAM-1 andalternatively or additionally high level expression of the markerrecognised by the monoclonal antibody STRO-1. Alternatively oradditionally enrichment may be carried out using 3G5.

Markers associated with perivascular cells may also be present on theMPCs, for example alpha smooth muscle actin (αSMA).

Other early developmental markers associated with MPCs may also bepresent. These may include but are not necessarily limited to the groupconsisting of THY-1, VCAM-1, ICAM-1, PECAM-1, CD49a/CD49b/CD29,CD49c/CD29, CD49d/CD29, CD29, CD61, integrin beta 5, 6-19,thrombomodulin, CD10, CD13, SCF, STRO-1bri, PDGF-R, EGF-R, IGF1-R,NGF-R, FGF-R, Leptin-R (STRO-2). Positive expression of one or more ofthese markers may be used in methods of enriching for MPCs from sourcetissue.

The MPCs of the present invention may also be characterised by theabsence of markers present in differentiated tissue, and enrichment maybe based on the absence of such markers.

Similarly it is preferred that the enriched cell populations are not ofhaemopoietic origin and thus it is preferred that these cells are notpresent. Markers characteristically identified as not present includebut are not limited to CD34, CD45 and glycophorin A. Additional othermarkers for this purpose might include CD20 and CD19 (B lymphocytemarkers), CD117 (c-kit oncoprotein) present on hemopoietic stem cellsand angioblasts, CD14 (macrophage), CD3 and CD4 (T cells).

It may be desirable to use the relatively quiescent, directly enrichedor isolated perivascular MCPs. Alternatively it has been discovered thatexpansion of the enriched population can be carried out and have thebeneficial effect of resulting in much greater numbers of cells. Theeffect of expansion of the directly enriched pool of cells is, however,that some differentiation of the initial MCPs will occur. Expansion overa 5 week period might result in an increase of 10³ fold. Other periodsmight be chosen to expand the population to between 10² to 10⁵ fold.This potential might be directed by culturing them is media containingcytokines and other factors directing the differentiation to aparticular tissue type for example PDGF and VEGF forming smooth musclealpha cords. These could then be introduce into a tissue with, forexample, an insult to assist with repair. Alternatively it may bedesired after expansion to re select cells on the basis of an earlydevelopmental marker, that might be STRO-1^(bri) to increase theproportion of MPCs in the population.

It is found that an essentially pure population of MCPs is not necessaryto provide for formation of differentiated cells to form desired tissuestructures. The enriched population may have levels of MCPs of greaterthan about 0.001, 0.01, 0.02, 0.05, 0.1, 0.2, 0.5 or 1% or higher as aproportion of total cell numbers in the enriched population. This orderof enrichment can be achieved by the use of a single marker forselection of the enriched MCP population. This is particularly so wherethe source tissue has an inherently high level of perivascular MCPs. Itis found that considerably more 3G5 pos MCPs are present in certaintissue, for example dental pulp, than in bone marrow. Thus in bonemarrow 3G5 positive MPCs constitute about 15% of MPC based on STR1^(bri)colony forming cells, whereas in dental pulp that are found toconstitute 65% and greater than 90% in fat and skin tissues. Expansionof the population and then re-enrichment using a single marker coungresult in higher leves of MPCs, perhaps levels greater than about 0.1,0.5, 1, 2, 5 or 10%

Whilst it is considered desirable that a substantial proportion andpreferably a majority of precursor cells are perivascular MPCs, it isnot considered essential for certain forms of the invention forperivascular MPCs to be the sole precursor cell form. Other forms ofprecursors may also be present without unduly interfering with thecapacity of the perivascular MPCs to undergo the desireddifferentiation. Such other forms may include haemopoietic precursors ornon-perivascular MPCs, perhaps being negative for 3G5.

Certain forms of the present invention provide perivascular MPCssubstantially free of endothelial cells. In that context substantiallyfree might be considered to be less than about 5, 2, 1, or 0.1%endothelial cells. Alternatively the context might be an assessment thatthe enriched population is von Willebrand Factor negative.

It will be understood that recognition of cells carrying the cellsurface markers that form the basis of the separation can be effected bya number of different methods, however, all of these methods rely uponbinding a binding agent to the marker concerned followed by a separationof those that exhibit binding, being either high level binding, or lowlevel binding or no binding. The most convenient binding agents areantibodies or antibody based molecules, preferably being monoclonalantibodies or based on monoclonal antibodies because of the specificityof these latter agents. Antibodies can be used for both steps, howeverother agents might also be used, thus ligands for these markers may alsobe employed to enrich for cells carrying them, or lacking them.

The antibodies may be attached to a solid support to allow for a crudeseparation. The separation techniques should maximise the retention ofviability of the fraction to be collected. Various techniques ofdifferent efficacy may be employed to obtain relatively crudeseparations. The particular technique employed will depend uponefficiency of separation, associated cytotoxicity, ease and speed ofperformance, and necessity for sophisticated equipment and/or technicalskill. Procedures for separation may include, but are not limited to,magnetic separation, using antibody-coated magnetic beads, affinitychromatography and “panning” with antibody attached to a solid matrix.Techniques providing accurate separation include but are not limited toFACS.

It is in the context of these methods that a cell be either negative orpositive. The positive cells may either be low (lo) or a hi (bright)expresser depending on the degree to which the marker is present on thecell surface, the terms relate to intensity of fluorescence or othercolor used in the color sorting process of the cells. The distinction oflo and bri will be understood in the context of the marker used on aparticular cell population being sorted.

The method of enriching for perivascular MPCs might include the step ofmaking a first partially enriched pool of cells by enriching for theexpression of a first of the markers, and then the step of enriching forexpression of the second of the markers from the partially enriched poolof cells.

It is preferred that the method comprises a first step being a solidphase sorting step, based on recognition of one or more of the markers.The solid phase sorting step of the illustrated embodiment utilises MACSrecognising high level expression of STRO-1. This then gives an enrichedpool with greater numbers of cells than if a high accuracy sort was usedas a first step. If for example FACS is used first, many of theprecursor cells are rejected because of their association with othercells. A second sorting step can then follow using an accurateseparation method. This second sorting step might involve the use of twoor more markers. Thus in the illustrated embodiment two colour FACS isused to recognise high level expression of the antigen recognised bySTRO-1 as wells as the expression of CD146. The windows used for sortingin the second step can be more advantageously adjusted because thestarting population is already partially enriched.

The method of enriching for perivascular MPCs might also include theharvesting of a source of the stem cells before the first enrichmentstep using known techniques. Thus the tissue will be surgically removed.Cells comprising the source tissue will then be separated into a socalled single cells suspension. This separation may be achieved byphysical and or enzymic means.

The preferred source of such perivascular MPCs is human, however, it isexpected that the invention is also applicable to animals, and thesemight include agricultural animals such as cows, sheep, pigs and thelike, domestic animals such as dogs, laboratory animals such as mice,rats, hamsters, and rabbits or animals that might be used for sport suchas horses.

In a further form the invention might be said to reside a method ofgeneration tissue in a mammal comprising the step of enriching apopulation of precursor cells as in the first aspect of the invention,and introducing the enriched population into the mammal, and allowingthe enriched population to generate the tissue in the mammal.

Another potential use for enriched cells of the present invention is asa means of gene therapy, by the introduction of exogenous nucleic acidsfor expression of therapeutic substances in the tissue types concerned.

In the context of the present invention the term isolated cell may meanthat perivascular MPCs comprise at least 30, 40, 50, 60, 70, 80, or 95%of total cells of the population in which they are present.

EXAMPLE 1 Isolation and Expansion of Precursor Cells

Stem cell niches identified in a number of different adult tissuesincluding skin, hair follicles, bone marrow, intestine, brain, pancreasand more recently dental pulp, are often highly vascularized sites.⁽¹⁾The maintenance and regulation of normally quiescent stem cellpopulations is tightly controlled by the local microenvironmentaccording to the requirements of the host tissue.^((2,3)) Both thesupportive connective tissues of bone marrow and dental pulp containstromal stem cell populations with high proliferative potentials capableof regenerating their respective microenvironments with remarkablefidelity, including the surrounding mineralized structures of bone anddentin.^((4,5)) In the postnatal organism, bone marrow stroma exists asa loosely woven, highly vascularized tissue that supports and regulateshematopoiesis.^((6,8)) At a time when many tissues have lost ordecreased their ability to regenerate, adult bone marrow retains acapacity for continuous renewal of haematopoietic parenchymal tissue andis responsible for remodeling the adjoining bone surfaces.^((9,10)) Incontrast, the inner pulp chamber of teeth is comprised of anon-hematopoietic, compact fibrous tissue, infiltrated by amicrovascular network, that is entombed by mineralized dentin.⁽¹¹⁻¹³⁾Following tooth maturation, dental pulp becomes relatively static,acting only in a reparative capacity in response to a compromised dentinmatrix caused by insults such as caries or mechanical trauma.

Precursors of functional osteoblasts (BMSSCs: bone marrow stromal stemcells) and odontoblasts (DPSCs: dental pulp stem cells), both forms ofMPCs identified by their source tissue, were initially identified bytheir capacity to form clonogenic cell clusters in vitro, a commonfeature amongst different stem cell populations.^((4,14-18)) The progenyof ex vivo expanded BMSSCs and DPSCs share a similar gene expressionprofile for a variety of transcriptional regulators, extracellularmatrix proteins, growth factors/receptors, cell adhesion molecules, andsome, but not all lineage markers characteristic of fibroblasts,endothelial cells, smooth muscle cells and osteoblasts.⁽⁴⁻¹⁹⁾ However,previous studies have documented that individual BMSSC coloniesdemonstrate marked differences in their proliferation rates in vitro anddevelopmental potentials in vivo.^((5,14,20)) Similar to these findings,we have recently observed comparable levels of heterogeneity in thegrowth and developmental capacity of different DPSC colonies.⁽²¹⁾Together, these studies infer a hierarchical arrangement of stromalprecursor cells residing in bone marrow and dental pulp, headed by aminor population of highly proliferative pluri-potential stem cells thatgive rise to committed bi- and uni-potential progenitor cellpopulations.⁽²²⁾

Despite our extensive knowledge about the properties of cultured BMSSCsand DPSCs, we still do not know if their in Vitro characteristics are anaccurate portrait of their true gene expression patterns anddevelopmental potentials in situ. In addition, it is not formally knownif all of the colony-forming cells within each tissue are derived fromone pluri-potent stem cell pool or whether they arise from committedprogenitors belonging to distinct lineages. There is also a lack ofinformation regarding the precise anatomical location of BMSSCs andDPSCs in their respective tissues. This is mainly attributed to therarity of stem cells and the absence of specific markers that identifydifferent developmental stages during osteogenesis and odontogenesis,particularly for primitive subpopulations. It has previously beenhypothesized that one possible niche for precursors of osteoblasts andodontoblasts may be the microvasculature networks of bone marrow anddental pulp, respectively.^((23,24))

Materials and Methods

Tissue Samples

Iliac crest-derived bone marrow mononuclear cells (BMMNCs), from normalhuman adult volunteers were obtained under guidelines set by the RoyalAdealaide Hospital Human Ethics Committee. Normal human impacted thirdmolars were collected from young adults the University of AdelaideDental Clinic Research under approved guidelines set by the Universityof Adelaide Human Ethics Committee, respectively. Discarded fullthickness skin and peripheral adipose tissue were obtained from routineplastic surgery procedures from the Skin Cell Engineering Laboratory,under the guidelines set by the Royal Adelaide Hospital Human EthicsCommittee. The pulp tissue was separated from the crown and root aspreviously described.⁽⁴⁾ Single cell suspensions of dental pulp, skinand adipose tissue were prepared by enzymatic digestion in a solution of3 mg/ml collagenase type I (Worthington Biochem, Freehold, N.J.) and 4mg/ml dispase (Boehringer Mannheim, GMBH, Germany) for one to threehours at 37° C. Single cell suspensions were obtained by passing thecells through a 70 μm strainer (Falcon, BD Labware, Franklin Lakes,N.J.). Cell (0.01 to 1×10⁵/well) preparations of bone marrow, dentalpulp, skin and adipose were then used for either, immunoselection, RNAextraction, or direct culture in 6-well plates (Costar, Cambridge,Mass.) as described below.

Other human tissue specimens (Brain, liver, heart, kidney, lung, spleen,thymus, lymph node, pancreas, skin) were obtained from autopsies carriedout at the Royal Adelaide Hospital during routine pathologicalexaminations under approved guidelines set by the Royal AdelaideHospital Human Ethics Committee. Small specimens approximately 0.5 cm²of each tissue type were placed into Tissue-Tek II cryomoulds 25 mm×20mm×5 mm (Miles Laboratories; Naperville, Ill.) and embedded with O.C.T.compound medium (Miles Laboratories) by immersion into a 150 ml to 200ml pyrex glass beaker of iso-pentane (BDH Chemicals, Poole, England)pre-cooled by suspending a glass beaker into a bath of liquid nitrogen.The isopentane has cooled when the bottom of the glass is white. Thefrozen sections were immediately stored at −80° C. Frozen sections ofnerve and muscle tissue were obtained from the Histopathology Departmentof the I.M.V.S., South Australia and sections of foreskin were obtainedfrom the Immunology Department of the I.M.V.S., South Australia.Sections of formalin fixed, paraffin embedded human foetal limb (52days) were kindly provided by Dr. T. J. Khong from the Department ofHistopathology, Women's and Children's Hospital, Adelaide, SouthAustralia.

Colony Efficiency Assay and Culture

Single cell suspensions were plated at low plating densities (between1,000 and 10,000 cells per well, as triplicates in six well plates) toassess colony-forming efficiency of different immunoselected cellfractions. The cells were cultured in alpha-Modification of Eagle'sMedium supplemented with 20% foetal calf serum, 2 mM L-Glutamine, 100 μML-ascorbate-2-phosphate, 100 U/ml penicillin and 100 μg/ml streptomycinat 37° C. in 5% CO₂. Day 14 cultures were fixed with 4% formalin, andthen stained with 0.1% toluidine blue. Aggregates of equal to or greaterthan fifty cells were scored as clonogenic colonies equivalent to colonyforming units-fibroblastic (CFU-F).

Magnetic-Activated Cell Sorting (MACS)

This procedure is a modification of that described elsewhere.⁽²⁵⁾Briefly, approximately 1×10⁸ BMMNCs were incubated with STRO-1brisupernatant (murine anti-human BMSSCs, IgM)⁽²⁹⁾ (½) for 1 hour on ice.The cells were then washed with PBS/5% FBS and resuspended in a 1/50dilution of biotinylated goat anti-mouse IgM (μ-chain specific; CaltagLaboratories, Burlingame, Calif.) for 45 minutes on ice. After washing,the cells were incubated with streptavidin microbeads (Miltenyi Biotec,Bergisch Gladbach, F.R.G.) for 15 minutes on ice, then separated on aMini MACS magnetic column (Miltenyi Biotec) according to themanufacturers recommendations.

Fluorescence Activated Cell Sorting (FACS)

STRO-1bri MACS isolated cells were incubated with a streptavidin-FITCconjugate ( 1/50; CALTAG Laboratories) for 20 minutes on ice then washedwith PBS/5% FBS. Single-color fluorescence activated cell sorting (FACS)was performed using a FACStar^(PLUS) flow cytometer (Becton Dickinson,Sunnyvale, Calif.). Dual color-FACS analysis was achieved by incubatingMACS-isolated STRO-1^(bri) BMMNCs with saturating (1:1) levels of CC9antibody supernatant (mouse anti-human CD146/MUC-18/Mel-CAM, IgG_(2a),Dr. Stan Gronthos) for one hour on ice. After washing with PBS/5% FBS,the cells were incubated with a second label goat anti-mouse IgG₂a(γ-chain specific) phycoerythrin (PE) conjugate antibody ( 1/50, CALTAGLaboratories) for 20 minutes on ice. The cells were then sorted usingthe automated cell deposition unit (ACDU) of a FACStar^(PLUS) flowcytometer. Limiting dilution assay: seeded 1, 2, 3 4, 5, & 10 cells perwell, 24 replicates, cultured in serum-deprived medium for 10 days aspreviously described⁽²⁶⁾. Similarly, freshly prepared unfractionatedBMMNCs were incubated with CC9 (IgG_(2a)) and 3G5 (IgM) antibodies orisotype-matched negative control antibodies for one hour on ice. Afterwashing with PBS/5% FBS, the cells were incubated with a second labelgoat anti-mouse IgG_(2a) (γ-chain specific) phycoerythrin (PE) and IgM (1/50; CALTAG Laboratories) conjugated antibodies for 30 minutes on ice.Cells were washed in PBS/%5 FBS prior to being analysed using aFACStar^(PLUS) flow cytometer. Positive reactivity for each antibody wasdefined as the level of fluorescence greater than 99% of the isotypematched control antibodies.

Flow Cytometric Analysis

Single cell suspensions of ex vivo expanded bone marrow MPC wereprepared by trypsin/EDTA treatment then incubated with neat STRO-1supernatant or antibodies identifying different cell lineage-associatedmarkers (10 μg/ml) for one hour on ice. The cells were then washed inPBS/5% FBS then incubated either with a goat anti-murineIgM-phycoerythrin (1/50, Southern Biotechnologies), goat anti-murine oranti-rabbit IgG-phycoerythrin (Caltag Laboratories). For thoseantibodies identifying intracellular antigens, cell preparations werepermeabilize the cellular membrane prior to staining for intracellularmarkers. Isotype matched control antibodies were treated under identicalconditions. Flow cytometric analysis was performed using a COULTER EPICSinstrument. The dot plots represent 5,000 listmode events indicating thelevel of fluorescence intensity for each lineage cell marker withreference to the isotype matched negative control antibodies.

Immunohistochemistry

Human tissue sections (μm) were de-waxed in xylene and rehydratedthrough graded ethanol into PBS. Frozen tissue sections (μm) andcytospin preparations were fixed with cold acetone at −20° C. for 15minutes then washed in PBS. The samples were subsequently treated withPBS containing 1.5% of hydrogen peroxide for 30 minutes, washed thenblocked with 5% non-immune goat serum for 1 hour at room temperature.Samples were incubated with primary antibodies for 1 hour at roomtemperature. Antibodies used: Mouse (IgG₁ & Ig_(2a)) controls (Caltag,Burlingame, Calif.); Rabbit (Ig) control, 1A4 (anti-α smooth muscleactin, IgG₁), 2F11 (anti-neurofilament, IgG₁), F8/86 (murine anti-vonWillebrand Factor, IgG₁) (Dako, Carpinteria, Calif.); STRO-1; CC9(anti-CD146); LF-151 (rabbit anti-human dentinsialoprotein; Dr. L.Fisher, NIDCR/NIH, MD). Working dilutions: rabbit serum ( 1/500),monoclonal supernatants (½) and purified antibodies (10 μg/ml). Singlestaining was performed by incubating the samples with the appropriatesecondary antibody, biotinylated goat anti-mouse IgM, IgG₁, IgG_(2a) orbiotinylated goat anti-rabbit for one hour at room temperature (CaltagLaboratories). Avidin-Peroxidase-complex and substrate were then addedaccording to the manufacturer instructions (Vectastain ABC Kit standard,Vector Laboratories). Samples were counterstained with hematoxylin andmounted in aqueous media. Dual-fluorescence labeling was achieved byadding the secondary antibodies, goat anti-mouse IgM-Texas Red

and IgG-FITC (CALTAG Laboratories), for 45 minutes at room temperature.After washing the samples were mounted in VECTASHIELD fluorescencemountant.

Immunomagnetic Bead Selection

Single cell suspensions of dental pulp tissue were incubated withantibodies reactive to STRO-1 (½), CD146 (½), or 3G5 (½) for 1 hour onice. The cells were washed twice with PBS/1% BSA then incubated witheither sheep anti-mouse IgG-conjugated or rat anti-mouse IgM-conjugatedmagnetic Dynabeads (4 beads per cell: Dynal, Oslo, Norway) for 40minutes on a rotary mixer at 4° C. Cells binding to beads were removedusing the MPC-1 magnetic particle concentrator (Dynal) following themanufactures recommended protocol.

Matrigel-Arteriole Assay

Single cell suspensions of ex vivo expanded bone marrow STRO-1^(bright)MPC were prepared by trypsin/EDTA treatment then plated into 48-wellplates containing 200 μl of matrigel. The STRO-1^(bright) MPC wereplated at 20,000 cells per well in serum-free medium (Gronthos et al.2003) supplemented with the growth factors PDGF, EGF, VEGF at 10 ng/ml.Following 24 hours of culture at 37° C. in 5% CO₂, the wells were washedthen fixed with 4% paraformaldehyde. Immunohistochemical studies weresubsequently performed for alpha-smooth muscle actin identified with agoat-anti-murine IgG horse radish peroxidase antibody/Vectastaining Kitas described above.

Osteogenic, Adipogenic and Chondrogenic Differentiation of MPC In Vitro

Single cell suspensions of ex vivo expanded adipose-derived MPC werecultured in αMEM supplemented with 10% FCS, 100 μML-ascorbate-2-phosphate, dexamethasone 10⁻⁷M and 3 mM inorganicphosphate previously shown to induce bone marrow MPC to form amineralized bone matrix in vitro (Gronthos et al., 2003). Mineraldeposits were identified by positive von Kossa staining. Adipogenesiswas induced in the presence of 0.5 mM methylisobutylmethylxanthine, 0.5μM hydrocortisone, and 60 μM indomethacin as previously described(Gronthos et al. 2003). Oil Red O staining was used to identifylipid-laden fat cells. Chondrogenic differentiation was assessed inaggregate cultures treated with 10 ng/ml TGF-β3 as described (Pittengeret al., 1999)

In Vivo Transplantation Studies

Approximately 5.0×10⁶ of ex vivo expanded cells derived from eitherSTRO-1^(bri)/CD146⁺ BMSSCs or CD146⁺ DPSCs were mixed with 40 mg ofhydroxyapatite/tricalcium phosphate (HA/TCP) ceramic powder (Zimmer Inc,Warsaw, Ind.) and then transplanted subcutaneously into the dorsalsurface of 10-week-old immunocompromised beige mice (NIH-bg-nu-xid,Harlan Sprague Dawley, Indianapolis, Ind.) as previously described.⁽⁴⁾These procedures were performed in accordance to specifications of anapproved animal protocol (NIDCR #00-113).

Reverse Transcription-Polymerase Chain Reaction.

Total RNA was prepared from STRO-1^(BRT)/CD146⁺ sorted BMMNCs, andcontrol cells (prim BMSSC cultures grown in the presence of 10⁻⁷ Mdexamethasone for three weeks) using RNA STAT-60 (TEL-TEST Inc.Friendswood Tex.). First-strand cDNA synthesis was performed with afirst-strand cDNA synthesis kit (GIBCO BRL, Life Technologies) using anoligo-dT primer. First strand cDNA (2 μl) was added to 46 μl of a 1×PCRmaster reaction mix (Roche Diagnostics, Gmbh Mannheim Germany) and 10pMol of each human specific primer sets: CBFA1 (632 bp, and threesmaller alternative splice variants)⁽²⁷⁾ sense5′-CTATGGAGAGGACGCCACGCCTGG-3′ [SEQ ID NO. 1], antisense,5′-CATAGCCATCGTAGCCTTGTCCT-3′ [SEQ ID NO. 2]; osteocalcin (310 bp)⁽⁴⁾sense, 5′-CATGAGAGCCCTCACA-3′ [SEQ ID NO. 3], antisense,5′-AGAGCGACACCCTAGAC-3′ [SEQ ID NO. 4]; GAPDH (800 bp)⁽⁴⁾ sense,5′-AGCCGCATCTTTTGCGTC-3′ [SEQ ID NO. 5]; antisense5′-TCATATTTGGCAGGTTTTTCT-3′ [SEQ ID NO. 6]. The reactions were incubatedin a PCR Express Hybaid thermal cycler (Hybaid, Franklin, Mass.) at 95°C. for 2 minutes for 1 cycle then 94° C./(30 sec), 60° C./(30 sec), 72°C./(45 sec) for 35 cycles, with a final 7 minute extension at 72° C.Following amplification, each reaction was analyzed by 1.5% agarose gelelectrophoresis, and visualized by ethidium bromide staining.

Results

BMSSCs and DPSCs Express Vascular Associated Antigens STRO-1 and CD146In Vivo.

We have previously demonstrated the efficacy of magnetic activated cellsorting (MACS), to isolate and enrich for all detectable clonogeniccolonies from aspirates of human marrow, based on their high expressionof STRO-1 antigen^((25,26)) To further characterize BMSSCs we incubatedthe STRO-1^(bri) MACS isolated cells with another monoclonal antibody,CC9,⁽²⁸⁾ that recognizes the cell surface antigen CD146, also known asMUC-18, Mel-CAM and Sendo-1, that is present on endothelial and smoothmuscle cells. These studies determined that CC9, selectively bound theSTRO-1 bright expressing fraction (STRO-1^(BRT)) from the total STRO-1⁺population by dual-color FACS analysis (FIG. 1A). Cloning efficiencyassays using Poisson distribution statistics, yielded a marked increasein the incidence of BMSSCs (1 colony per 5 STRO-1^(BRT)/CD146⁺ cellsplated), and achieved a 2×10³ fold enrichment of the clonogenic colonypopulation when compared to unfractionated marrow (FIG. 1B). No colonyformation could be detected in STRO-1^(BRT)/CD146⁻ cell fraction (datanot shown).

The light scatter properties of STRO-1^(BRT)/CD146⁺ marrow cells weretypically larger and more granular than the nucleated erythroid cellsand B-lymphocytes comprising the bulk of the STRO-1⁺ population⁽²⁹⁾(FIG. 1C-E). Cytospin preparations of STRO-1^(BRT)/CD146⁺ sorted cellswere found to be negative for the erythroid (glycophorin-A) andleukocyte (CD45) associated markers (data not shown). Confirmation thatBMSSCs represented an early osteogenic precursor population was obtainedby RT-PCR analysis of highly purified MACS/FACS-isolatedSTRO-1^(BRT)/CD146⁺ cells, which failed to detect the early and lateosteogenic, markers CBFA1 and osteocalcin, respectively (FIG. 1F).However, the progeny of STRO-1^(BRT)/CD146⁺ sorted BMSSCs were found toexpress both CBFA1 and osteocalcin, following ex vivo expansion.Immunolocalization studies demonstrated that the CD146 antigen waspredominantly expressed on blood vessel walls in sections of human bonemarrow (FIG. 1G). Localization of both STRO-1 and CD146 was confined tolarge blood vessels in frozen sections of human bone marrow trephine(FIG. 1H).

Immunoselection protocols were subsequently used to determine if humanDPSCs also expressed STRO-1 and CD146 in situ. The use of either MACS orFACS analysis to isolate DPSCs was restrictive due to the rarity ofthese cells (1 colony-forming cell per 2×10³ cells plated) compounded bythe limited number of pulp cells (approximately 10⁵ cells per pulpsample) obtained following processing. To circumvent this, we pooledseveral pulp tissues obtained from 3 to 4 different third molars perexperiment and employed immunomagnetic bead selection on single cellsuspensions of pulp tissue, based on their expression of either theSTRO-1 or CD146 antigens. The STRO-1⁺ fraction represented approximately6% of the total pulp cell population. Comparative studies demonstratedthat growth rates of individual colonies were unperturbed in thepresence of magnetic beads (data not shown). Colony efficiency assaysindicated that the majority of dental pulp derived colony-forming cells(82%) were represented in the minor, STRO-1⁺ cell fraction analogous toBMSSCs (FIG. 2). The mean incidence of DPSCs in the STRO-1 positivefraction (329 colony-forming cells per 10⁵ cells plated±56 SE, n=3) wassix-fold greater than unfractionated pulp cells (55 colony-forming cellsper 10³ cells plated±14 SE, n=3). Using a similar strategy, differentfractions of human dental pulp cells were selected based on theirreactivity with the antibody, CC9. Colony efficiency assays showed thata high proportion (96%) of dental pulp-derived clonogenic colonies werealso present in the CD146⁺ population, using immunomagnetic Dynal beadselection (FIG. 2). The mean incidence of clonogenic colonies in theCD146⁺ fraction (296 colony-forming cells per 10⁵ cells plated±37 SE,n=3) was seven-fold greater than unfractionated pulp cells (42colony-forming cells per 10⁵ cells plated±9 SE, n=3).

Immunolocalization studies showed that STRO-1 expression was restrictedto blood vessel walls and perineurium surrounding the nerve bundles, butwas not present in the mature odontoblast layer or fibrous tissue, infrozen sections of human dental pulp tissue (FIG. 3A-B). Furthermore,co-localization of CD146 with STRO-1 was detected on the outer bloodvessel cell walls, with no reactivity to the surrounding fibrous tissue,odontoblast layer, and the perineurium of the nerve FIG. 3C-D).Importantly, expression of human odontoblast-specific differentiationmarker, dentinsialoprotein (DSP), was restricted to the outer pulpallayer containing mature odontoblasts (FIG. 3E) and was absent in fibroustissue, nerve bundles and blood vessels.

Differential Expression of the Perivascular Marker 3G5 by BMSSCs andDPSCs.

In the present study, flow cytometric analysis revealed that the cellsurface antigen, 3G5, was highly expressed by a large proportion (54%)of hematopoietic marrow cells (FIG. 4A). This observation eliminated 3G5as a candidate marker for isolating purified populations of BMSSCsdirectly from aspirates of human marrow. In addition, dual-FACS analysisbased on 3G5 and STRO-1 expression was not possible since bothantibodies shared the same isotype. Nevertheless, in vitro colonyefficiency assays for different 3G5/CD146 FACS sorted subfractionsdemonstrated that only a minor proportion (14%) of bone marrowclonogenic colonies expressed the 3G5 antigen at low levels (FIG. 4B).Conversely, a larger proportion (63%) of clonogenic DPSCs (192colony-forming cells per 10⁵ cells plated±18.4 SE n=3) were present inthe 3G5⁺ cell fraction following immunomagnetic bead selection (FIG. 2).3G5 demonstrated specific reactivity to pericytes in frozen sections ofhuman dental pulp tissue (FIG. 3F).

We next analyzed the expression of more specific markers of endothelialcells (von Willebrand Factor) and smooth muscle cells/pericytes(α-smooth muscle actin) on cytospin preparations using freshly isolatedSTRO-1^(BRT)/CD146⁺ BMSSCs and CD146⁺ expressing DPSCs. A largeproportion of purified BMSSCs (67%), were found to be positive forα-smooth muscle actin (FIG. 5A), but lacked expression of von WillebrandFactor (FIG. 5B). Similarly, the majority of isolated DPSCs (85%) werealso found to express α-smooth muscle actin, but not von WillebrandFactor (FIG. 5C, 5D). Purified populations of STRO-1^(BRT)/CD146⁺ BMSSCsand CD146⁺ DPSCs were subsequently expanded in vitro then transplantedinto immunocompromised mice to assess their developmental potentials invivo. The progeny of cultured BMSSCs and DPSCs displayed distinctcapacities, capable of regenerating the bone marrow and dental/pulpmicroenvironments, respectively (FIG. 5E, F), and appeared identical tothe developmental potential of non-selected multi-colony derived BMSSCsand DPSCs (4).

Discussion

The present study provides direct evidence that two mesenchymal stemcell populations, distinct in their ontogeny and developmentalpotentials, are both associated with the microvasculature of theirrespective tissues.

We employed different immunoselection protocols to demonstrate thatBMSSCs and DPSCs could be efficiently retrieved from bone marrowaspirates and enzyme digested pulp tissue respectively, based primarilyon their high expression of the STRO-1 antigen. This cell surfaceantigen is present on precursors of various stromal cell typesincluding, marrow fibroblasts, osteoblasts, chondrocytes, adipocytes,and smooth muscle cells isolated from human adult and fetal bonemarrow.^((29,32-34)) Previous studies have implicated STRO-1 as a markerof pre-osteogenic populations, where its expression is progressivelylost following cell proliferation and differentiation into matureosteoblasts in vitro.^((27,35,36)) The STRO-1 antigen was also found tobe present on the outer cell walls of human bone marrow and dental pulpblood vessels, in accord with previous studies that localized STRO-1 onlarge blood vessels, but not capillaries, in different adult tissuessuch as brain, gut, heart, kidney, liver, lung, lymph node, muscle,thymus.⁽⁶⁾ Therefore, STRO-1 appears to be an early marker of differentmesenchymal stem cell populations and infers a possible perivascularniche for these stem cell populations in situ.

To determine if BMSSCs and DPSCs were associated directly with bloodvessels we utilized another antibody (CC9),⁽²⁸⁾ which recognizes theimmunoglobulin super family member, CD146 (MUC-18/Mel-CAM), known to bepresent on smooth muscle, endothelium, myofibroblasts and Schwann cellsin situ, as well as being a marker for some human neoplasms.⁽³⁷⁾Notably, CD146 is not expressed by bone marrow hematopoietic stem cells,nor their progenitors. While the precise function of CD146 is not known,it has been linked to various cellular processes including celladhesion, cytoskeletal reorganization, cell shape, migration andproliferation through transmembrane signaling.

In order to dissect the BMSSC population, STRO-1^(BRT) expressing marrowcells were further distinguished from STRO-1⁺ hematopoietic cells(predominantly glycophorin-A⁺ nucleated erythrocytes) based on theirexpression of CD146, using dual-FACS analysis. PurifiedSTRO-1^(BRT)/CD146⁺ human BMSSCs displayed light scatter propertiescharacteristic of large granular cells. Our study supports the findingsof Van Vlasselaer and colleagues (1994)⁽³⁸⁾ who isolated partiallypurified BMSSCs from murine bone marrow following 5-fluoracil (5-FU)treatment, and identified this population as having high perpendicularand forward light scatter characteristics. Interestingly, freshlyisolated 5-FU resistant murine BMSSCs were also found to be positive fortwo perivascular markers Sab-1 and Sab-2.⁽³⁸⁾ Conversely, more recentstudies have shown that when BMSSCs are cultivated in vitro, the mostprimitive populations display low perpendicular and forward lightscatter properties⁽³⁹⁾ and therefore may not reflect the true morphologyof BMSSC in situ. In the present study, STRO-1^(BRT)/CD146⁺ sorted humanBMSSCs lacked the expression of CBFA1 and osteocalcin that identifycommitted early and late osteogenic populations, respectively,^((40,41))indicating that BMSSCs exhibit a pre-osteogenic phenotype in human bonemarrow aspirates. We found that a high proportion of freshly isolatedSTRO-1^(BRT)/CD146⁺ BMSSCs expressed α-smooth muscle actin, but not theendothelial specific marker von Willebrand Factor, providing directevidence that this primitive precursor population displays acharacteristic perivascular phenotype.

The present study also demonstrated the efficacy of using magnetic beadselection to isolate and enrich for DPSCs directly from human dentalpulp tissue based on their expression of either STRO-1 or CD146.Immunolocalization of CD146 appeared to be specific to themicrovasculature within dental pup. Co-localization of both STRO-1 andCD146 on the outer walls of large blood vessel in dental pulp tissue,implied that the majority of DPSCs arise from the microvasculature.However, since the STRO-1 antibody also reacted with the perineurium indental pulp and peripheral nerve bundles (unpublished observations),further investigation is required to determine the role of this antigenin neural cell development.

Analogous to BMSSCs, freshly isolated CD146⁺ DPSCs were found to expressα-smooth muscle actin but not von Willebrand Factor. DPSCs were alsoshown to be an immature pre-odontogenic population both by theirlocation distal from the dentin forming surface and by their lack ofexpression of the human odontoblast-specific dentin sialoprotein (DSP),which is restricted to the outer pulpal layer containing differentiatedodontoblasts. We have previously described that ex vivo expanded humanDPSCs do not express the precursor molecule, dentinsialophosphoprotein(DSPP), in vitro when cultured under non-inductive conditions.⁽⁴⁾Similar studies have shown that DSPP mRNA was highly expressed infreshly isolated odontoblast/pulp tissue, but was not detect in cultureddental papilla cells derived from rat incisors.^((43,44)) It is onlywhen DPSCs are induced, either in vitro,⁽⁴⁵⁾ or by in vivotransplantation to form an ordered dentin matrix that DSPP isexpressed.⁽⁴⁾

In vitro studies of ex vivo expanded BMSSCs and DPSCs supported thenotion that their progeny were morphologically similar to culturedperivascular cells having a bi-polar fibroblastic, stellar or flatmorphology, rather than a polygonal endothelial-like appearance. Inaddition, we have previously shown that the progeny of BMSSC- andDPSC-derived colonies exhibit heterogeneous staining for both CD146 andα-smooth muscle actin, but lack expression of the endothelial markers,CD34 and von Willebrand Factor, in vitro.⁽⁴⁾

The observations that two different mesenchymal stem cell populationssuch as BMSSCs and DPSCs harbour in perivascular niches may have furtherimplications for identifying stem cell populations in other adulttissues. Recent findings have identified human “reserve” multi-potentmesenchymal stem cells in connective tissues of skeletal muscle, anddermis derived from human fetal and adult samples.⁽⁵⁶⁾ However the exactlocation, developmental potential and ontogeny of these stem cells isstill largely unknown. In the present study, identification ofmesenchymal stem cell niches in bone marrow and dentin pulp may helpelucidate the fundamental conditions necessary to selectively maintainand expand primitive multi-potential populations in vitro, in order todirect their developmental potentials in vivo.

EXAMPLE 2 Adult Human Bone Marrow MPC are Distinct from StromalPrecursor Cells, Haematopoietic Stem Cells and Angioblasts by their HighExpression of the STRO-1 Antigen and Lack of CD34 Expression

Postnatal bone marrow appears to be a hub of residential stem andprecursor cell types responsible for blood cell formation(haematopoietic stem cells), endothelial development (angioblast), andconnective tissue/stromal differentiation (stromal precursor cells/bonemarrow stromal stem cells/mesenchymal stem cells). Recent work by ourgroup (Gronthos et al. 2003; Shi and Gronthos 2003) has, for the firsttime, purified and characterised human multipotential bone marrowmesenchymal precursor cells (MPC) based on their high expression of theSTRO-1 antigen and by their co-expression of the immunoglobulinsuperfamily members, VCAM-1 (CD106) and MUC-18 (CD146). Early studies bySimmons and Torok-Storb (1991a and b), have shown that bonemarrow-derived STRO-1+ stromal precursor cells, with the capacity toform adherent colonies in vitro, also expressed the haematopoietic stemcell marker, CD34, albeit at low levels. These studies used CD34antibody-complement mediated cell lysis to eliminate a high proportionof adherent colony-forming cells in marrow aspirates (Simmons andTorok-Storb 1991b). It is important to note that while the STRO-1antibody was generated following immunisation of mice with human CD34⁺bone marrow cells, this may have arisen due to the fact that the STRO-1antigen is also expressed at moderate to low levels onCD34⁺/Glycophorin-A⁺ nucleated red cells and CD34⁺/CD20⁺ B-lymphocytes.We now offer direct evidence, using sophisticated fluorescence activatedcell sorting technology that multipotential adult human bone marrow MPCexpress high levels of STRO-1, but lack expression to the stromalprecursor cell, haematopoietic stem cell and angioblast maker (CD34),the leukocyte antigen (CD45), and the nucleated red cell marker(Glycophorin-A) (FIG. 6A-C). These data demonstrate that adult humanbone marrow-derived MPC are a novel stem cell population, distinct frommore mature stromal precursor cells, haematopoietic stem cells andangioblast (FIG. 7).

Unless otherwise indicated the materials and methods of this example arethe same as those for Example 1.

FIG. 6. Expression of CD34, CD45 and Glycophorin-A on STRO-1 positivebone marrow mononuclear cells. Representative histograms depictingtypical dual-colour flow cytometric analysis profiles of STRO-1 positivebone marrow mononuclear cells isolated initially by magnetic activatedsorting and co-stained with antibodies directed against CD34 (A), CD45(B) or Glycophorin-A (C). The STRO-1 antibody was identified using agoat anti-murine IgM-fluorescein isothiocyanate while CD34, CD45 andGlycophorin-A were identified using a goat anti-murineIgG-phycoerythrin. The high expressing STRO-1 fraction which containedthe clonogenic MPC population was isolated by fluorescence activatedcell sorting based on regions R1 and R2.

FIG. 7. Bone marrow MPC are STRO-1 bright, CD34 negative, CD45 negativeand Glycophorin-A negative. The graph depicts the results of in vitroadherent colony formation assays performed for each of the differentsorted STRO-1 bright populations selected by their co-expression or lackof either the CD34, CD45 or Gycophorin-A antigens, based on regions R1and R2 as indicated in FIG. 6. These data are expressed as the meanincidence of colony-forming units for each cell fraction averaged fromtwo separate experiments.

EXAMPLE 3 Identification of Multipotential MPC in Different HumanTissues

While the existence and precise location of MPC in different tissues islargely unknown, we have recently demonstrated that MPC appear to residein a perivascular niche in human bone marrow and dental pulp tissues(Shi and Gronthos 2003). These observations were based on a combinationof immunohistochemical and immunoselection methods to identify andisolate different MPC populations based on their expression of themesenchymal stem cell marker, STRO-1, the smooth muscle and pericytemarkers, CD146, alpha-smooth muscle actin and the pericyte specificmarker, 3G5. We have now extended these studies demonstrating theco-localization of STRO-1/CD146, STRO-1/alpha-smooth muscle actin, and3G5/CD146 antigens in a wider variety of tissues including heart, liver,kidney, skin, spleen, pancreas, lymph node (FIG. 8A-8D).

To confirm our earlier findings that MPC can be derived from non-bonemarrow tissue such as dental pulp, we used fluorescence activated cellsorting to isolate different MPC populations from adult human peripheraladipose. Single cell suspensions were obtained following digestion ofthe adipose tissue with collagenase and dispase as previously described(Shi and Gronthos 2003). The adipose-derived cells were then incubatedwith antibodies reactive against STRO-1, CD146 and 3G5. Cell populationswere then selected by FACS, based on their positivity (region R3) ornegativity (region R2) to each marker and then plated into regulargrowth medium (Shi and Gronthos 2003) to assess the incidence ofadherent colony-forming cells in each cell fraction (FIG. 9). Following12 days of culture, colonies (aggregates of 50 cells or more) werescored and displayed as the number of colonies per 10⁵ cells plated foreach cell fraction. Our data demonstrated that MPC can be derived fromadipose tissues based on their expression of STRO-1/3G5/CD146 antigens(FIG. 10). Dual colour flow cytometric analysis confirmed that only aminor proportion of adipose-derived cells co-expressed STRO-1/CD146 and3G5/CD146 (FIG. 11). These findings are consistent with our previousobservations that MPC can be isolated from both bone marrow and dentalpulp tissue based on the same set of perivascular markers (Shi andGronthos 2003). Furthermore, we provide evidence demonstrating thatadipose derived MPC isolated by CD146 selection have the capacity todifferentiate into different tissues such as bone, fat and cartilage(FIG. 12), as previous described (Gronthos et al. 2003).

Recent findings examining the existence of MPC in unrelated tissues suchas skin has also been examined to further strengthen our hypothesis.Single cell suspensions were obtained following digestion of fullthickness human skin with collagenase and dispase as described above forhuman adipose tissue. The skin-derived cells were then incubated withantibodies reactive against STRO-1, CD146 and 3G5 identified usingeither a goat anti-murine IgM or IgG-phycoerythrin. Cell populationswere then selected by FACS, based on their positivity (region R3) ornegativity (region R2) to each marker and then plated into regulargrowth medium (Shi and Gronthos 2003) to assess the incidence ofadherent colony-forming cells in each cell fraction (FIG. 13). Following12 days of culture, colonies (aggregates of 50 cells or more) werescored and displayed as the number of colonies per 10⁵ cells plated foreach cell fraction. The data demonstrated that MPC can also be derivedfrom skin based on their expression of STRO-1/3G5/CD146 antigens (FIG.10). Collectively these data suggest that multipotential MPC can beidentified and isolated in virtually all vascularised tissues derivedfrom postnatal human tissue based on a common phenotype.

Unless otherwise indicated the materials and methods of this example arethe same as those for Example 1.

FIG. 8A-8D. Reactivity of perivascular makers in different humantissues. Dual-colour immunofluorescence staining demonstratingreactivity of (A) STRO-1 and CD146, (B) STRO-1 and alpha-smooth muscleactin, and (C) 3G5 and CD146, on blood vessels and connective tissuepresent on spleen, pancreas (Panel I), brain, kidney (Panel II), liver,heart (Panel III) and skin (Panel IV) 20.times. The STRO-1 and 3G5antibodies were identified using a goat anti-murine IgM-Texas Red whileCD146 and alpha-smooth muscle actin were identified using a goatanti-murine or IgG-fluorescein isothiocyanate. Co-localization isindicated by overlapping areas of yellow and orange fluorescence (whitearrows).

FIG. 9. Isolation of adipose-derived MPC by FACS. Representative flowcytometric histograms depicting the expression of STRO-1, CD146 and 3G5in fresh preparations of peripheral adipose-derived single-cellsuspensions generated following collagenase/dispase digestion aspreviously described (Shi and Gronthos 2003). The antibodies wereidentified using either a goat anti-murine IgM or IgG-phycoerythrin.Cell populations were then selected by FACS, based on their positivity(region R3) or negativity (region R2) to each marker and then platedinto regular growth medium to assess the incidence of adherentcolony-forming cells in each cell fraction.

FIG. 10. Clonogenic adipose-derived MPC are positive forSTRO-1/3G5/CD146. The bar graph depicts the number of clonogeniccolonies retrieved from single cell suspensions of enzymaticallydigested human peripheral adipose tissue, following fluorescenceactivated cell sorting, based on their reactivity to antibodies thatrecognize STRO-1, CD146, and 3G5 (FIG. 9), then cultured in standardgrowth medium as previously described for bone marrow and dental pulptissue (Shi and Gronthos 2003). The data are expressed as the number ofcolony-forming units obtained per 10⁵ cells plated in the positive andnegative cell fractions averaged from two separate experiments.

FIG. 11. Immnunophenotypic analysis of adipose-derived MPC.Representative flow cytometric histograms depicting the co-expression ofSTRO-1 and CD146 (A) and 3G5 and CD146 in fresh preparations ofperipheral adipose-derived single-cell suspensions generated followingcollagenase digestion. The STRO-1 and 3G5 antibodies were identifiedusing a goat anti-murine IgM-phycoerythrin while CD146 was identifiedusing a goat anti-murine IgG-fluorescein isothiocyanate. Approximately60% and 50% of the CD146 positive cells co-express STRO-1 and 3G5,respectively. These data suggest that 10% or more of the CD164 positivecells co-express STRO-1 and 3G5.

FIG. 12. Developmental potential of purified Adipocyte-derived MPC invitro. Preparations of primary MPC cultures derived from STRO-1⁺/CD146⁺adipose cells were re-cultured either in standard culture conditions(A), osteogenic inductive medium (B), Adipogenic inductive medium (C) orchondrogenic conditions (D) as previously described Gronthos et al.2003. Following two weeks of multi-differentiation induction, theadipocyte-derived MPC demonstrated the capacity to form bone (B;Alizarin positive mineral deposits), fat (C; Oil Red O positive lipid)and cartilage (D: collagen type II matrix).

FIG. 13. Isolation of skin-derived MPC by FACS. Representative flowcytometirc histograms depicting the expression of STRO-1, CD146 and 3G5in fresh preparations of fill thickness skin-derived single-cellsuspensions generated following collagenase/dispase digestion. Theantibodies were identified using either a goat anti-murine IgM orIgG-phycoerythrin. Cell populations were then selected by FACS, based ontheir positivity (region R3) or negativity (region R2) to each markerand then plated into regular growth medium to assess the incidence ofadherent colony-forming cells in each cell fraction.

FIG. 14. Clonogenic skin-derived MPC are positive forSTRO-1bri/3G5/CD146. The bar graph depicts the number of adherentcolonies recovered from single cell suspensions of enzymaticallydigested human skin, following fluorescence activated cell sorting,based on their reactivity to antibodies that recognize STRO-1, CD146,and 3G5, then cultured in standard growth medium as previously describedfor bone marrow and dental pulp tissue (Shi and Gronthos 2003). The dataare expressed as the number of colony-forming units obtained per 10⁵cells plated in the positive and negative cell fractions averaged fromtwo separate experiments.

EXAMPLE 4 Stro^(bright) Cells Induce Neovascularization (Angiogenesisand Arteriogenesis) and Result in Functional Improvement of IschemicMyocardial Tissue

FIG. 15. Engraftment and Survival of Human Stro^(bright) Cells InjectedInto Rat Tumors. Athymic nude rats were irradiated with 250 Gy for 5minutes to remove residual natural killer function, then injectedsubcutaneously in the flank with 1×10⁶ rat glioblastoma cells. Two weeksafter implantation, the glioblastoma tumors were directly injected witheither 500,000 Stro^(bright) cells, 500,000 Stro^(dim) cells or saline,and animals were sacrificed 7 days later. In ⅔ tumor tissues whichreceived Stro^(bright) cells, staining by immunoperoxidase method usinga monoclonal antibody with specific reactivity against human, but notrat, mitochondria, demonstrated numerous human cells around theinjection site, indicating medium-term engraftment and survival. Humancells were not detected in any of the three tissues receiving Stro^(dim)cells, suggesting that Stro^(bright) cells might have a survival orreplicative advantage in this in vivo model system (see panel A). TheStro^(bright) cells were predominantly in clusters nearby smallcapillaries and arterioles (small arrows) (panel B). In addition,several human cells were seen to incorporate into vascular structures(large arrow) (panel C). These data indicate that human Stro^(bright)cells can both induce neovascularization of endogenous (rat) vessels andcan become incorporated into new vessels of human origin.

FIG. 16. Induction Of Tumor Neovascularization (Angiogenesis AndArteriogenesis) By Human Stro^(bright) Cells. In consecutive sections ofthe tumor tissue stained by immunoperoxidase method using monoclonalantibodies directed, respectively, against von Willebrand Factor (vWF)and alpha-smooth muscle actin (alpha-SMA), animals injected withStro^(bright) cells demonstrated significantly greater numbers ofcapillaries and arterioles (defined, respectively, by vWF staining aloneand combined expression of vWF and alpha-SMA) than animals injected withsaline.

FIG. 17. Stro^(bright) Cells Are More Potent Inducers OfNeovascularization (Angiogenesis And Arteriogenesis) Than Stro^(dim)Cells. Quantitation of arteriolar numbers (defined as vascularstructures with lumen diameter>50 microns and circumferential expressionof alpha-SMA) demonstrated that animals injected with Stro^(bright)cells had almost eight-fold greater number of arterioles thansaline-treated controls at the site of injection (40±5 vs 6±2arterioles/high power field, p<0.01), while no difference could bedetected distal to the injection site. Animals injected with theStro^(dim) progeny demonstrated a modest, two-fold increase in thenumber of arterioles at the injection site relative to saline-treatedcontrols (13±3 vs 6±2 arterioles/high power field, p<0.01), indicatingthat the Stro^(bright) progeny contained the most potentpro-arteriogenic cells following in vitro culture.

FIG. 18. Dose-Dependent Effect Of Stro^(bright) Cells On MyocardialNeovascularization. To examine whether induction of angiogenesis andarteriogenesis could be extended to other tissues, and was associatedwith biological significance, cultured progeny of Stro-selected cellswere injected by direct intramyocardial injection into the peri-infarctregions of the ischemic hearts in athymic nude rats who had undergoneleft anterior descending coronary artery (LAD) ligation two daysearlier. Animals injected with 1×10⁶ Stro^(bright) cells demonstratedthree-fold greater numbers of arterioles at the peri-infarct region thananimals injected with saline (12±2 vs 4±1 arterioles/high power field,p<0.01). In contrast, animals injected with only 0.2×10⁶ Stro^(bright)cells, delivered in a total of 1×10⁶ unfractionated cultured progeny ofStro-selected cells, induced only 50% greater numbers of arterioles atthe peri-infarct region than saline (6±1 vs 4±1 arterioles/high powerfield, p<0.05), indicating that Stro^(bright) cells have adose-dependent effect on arteriolar induction in the ischemic heart.

FIGS. 19, 20 and 21. Stro^(bright)-Dependent MyocardialNeovascularization Results In Global Improvement of Parameters OfMyocardial Function. Applicants next examined the effects ofStro^(bright)-dependent myocardial neovascularization on globalparameters of cardiac function. As shown in FIG. 19, injection of about0.1-0.2×10⁶ and 1×10⁶ Stro^(bright) cells resulted in dose-dependentimprovement in ejection fraction (EF) at 2 and 6 weeks, as measured byechocardiography performed and analyzed by a blinded technician. Animalsreceiving 1×10⁶ Stro^(bright) cells demonstrated mean improvement in EFat 2 and 6 weeks of 50% and 75%, respectively, relative to baselinevalues two days post-LAD ligation. In stark contrast, saline-treatedanimals showed only 5% mean improvement in EF by 6 weeks (p<0.01), andanimals treated with Stro-depleted fresh bone marrow mononuclear cellsdemonstrated no difference compared with those receiving saline.Injection of 1×10⁶ Stro^(bright) cells resulted in similar dramaticimprovement in fractional area shortening (FAS) (mean improvement of 70%and 90% at 2 and 6 weeks, respectively, FIG. 20). Stro-depleted bonemarrow mononuclear cells again had no effect, while modest improvementwas seen after injection of about 01.-0.2×10⁶ Stro^(bright) cells.Finally, as shown in FIG. 21, injection of 1×10⁶ Stro^(bright) cellsresulted in significant improvement in left ventricular compliancecompared with saline-treated controls. Animals receiving Stro^(bright)cells demonstrated over 50% reduction in both left ventricular meanend-diastolic pressure and diastolic pressure (each p<0.01), and overtwo-fold improvement in dp/dt (p<0.01). Together, these results indicatethat the neovascularization (angiogenesis and arteriogenesis) ofischemic rat myocardium induced by injection of 1×10⁶ humanStro^(bright) cells resulted in significant improvement in both globalsystolic and diastolic parameters of cardiac function.

EXAMPLE 5 Immunophenotypic Analysis of Ex Vivo Expanded Human BoneMarrow Mesenchymal Precursor Cells

We have previously reported that multipotential mesenchymal precursorcells (&DC) can be purified from adult human bone marrow mononuclearcells based on the phenotype STRO-1^(bright)/VCAM-1 (CD106)⁺ orSTRO-1^(bright)/MUC-18 (CD146)⁺ (Gronthos et al. 2003; Shi and Gronthos2003). The MPC population can be readily propagated in vitro underdefined culture conditions (Gronthos et al. 2003). We now present datacharacterising the ex vivo expanded MPC progeny based on markersassociated with different cell lineages, at both the mRNA and proteinlevel, using reverse transcriptase-polymerase chain reaction (RT-PCR)and flow cytometric analysis, respectively.

In the first series of experiments, semi-quantitative RT-PCR analysiswas employed to examine the gene expression profile of variouslineage-associated genes present in the cultured MPC populations (FIG.23). Relative gene expression for each cell marker was assessed withreference to the expression of the house-keeping gene, GAPDH, usingImageQuant software (FIG. 23B). In addition, single-colour flowcytometric analysis was used to examine the protein expression profileof ex vivo expanded MPC based on their expression of celllineage-associated markers (FIG. 23A). A summary of the generalphenotype based on the gene and protein expression of the cultured MPCis presented in Table 1. Direct comparison of the gene expressionprofile of MPC described in the present patent demonstrated cleardifferences between this cell population and mesenchymal stem cells(MSC) previously described by Pittenger et al. 1999, (Table 1).

Unless otherwise indicated the materials and methods of this example arethe same as those for Example 1.

FIG. 23A. Immunophenotypic expression pattern of ex vivo expanded bonemarrow MPC. Single cell suspensions of ex vivo expanded bone marrow MPCwere prepared by trypsin/EDTA treatment then incubated with antibodiesidentifying cell lineage-associated markers. For those antibodiesidentifying intracellular antigens, cell preparations were fixed withcold 70% ethanol to permeabilize the cellular membrane prior to stainingfor intracellular markers. Isotype matched control antibodies weretreated under identical conditions. Flow cytometric analysis wasperformed using a COULTER EPICS instrument. The dot plots represent5,000 listmode events indicating the level of fluorescence intensity foreach lineage cell marker (bold line) with reference to the isotypematched negative control antibodies (thin line).

FIG. 23B. Gene expression profile of cultured MPC. Single cellsuspensions of ex vivo expanded bone marrow MPC were prepared bytrypsin/EDTA treatment and total cellular RNA was prepared. UsingRNAzolB exaction method total RNA was isolated and used as a templatefor cDNA synthesis, prepared using standard procedure. The expression ofvarious transcripts was assessed by PCR amplification, using a standardprotocol as described previously (Gronthos et al. 2003). Primers setsused in this study are shown in Table 2. Following amplification, eachreaction mixture was analysed by 1.5% agarose gel electrophoresis, andvisualised by ethidium bromide staining. Relative gene expression foreach cell marker was assessed with reference to the expression of thehouse-keeping gene, GAPDH, using ImageQuant software.

FIG. 22. Ex vivo expanded STRO-1^(bri) MPC can develop into arteriolesin vitro. Single cell suspensions of ex vivo expanded bone marrowSTRO-1^(bri) MPC were prepared by trypsin/EDTA treatment then platedinto 48-well plates containing 200 μl of matrigel. The STRO-1^(bri) MPCwere plated at 20,000 cells per well in serum-free medium (Gronthos etal. 2003) supplemented with the growth factors PDGF, EGF, VEGF at 10ng/ml. Following 24 hours of culture at 37° C. in 5% CO₂, the wells werewashed then fixed with 4% paraformaldehyde. Immunohistochemical studieswere subsequently performed demonstrated that the cord-like structuresexpressed alpha-smooth muscle actin identified with a goat-anti-murineIgG horse radish peroxidase antibody.

TABLE 1 Comparison between cultured human Mesenchymal Precursor Cells(MCP's) and cultured human Mesenchymal Stem Cells (MSC's) following exvivo expansion. Antigens found to be present on cell surface,intracellular or in the extra cellular matrix. MPCs express markers oftissues with different developmental origin, ie. ECT-ectoderm,MES-mesoderm and END - endoderm. Differentiated ANTIGEN MSC MPC CellType. STRO-1 −ve +ve Collagen II −ve +ve Chondrocyte (MES) Collagen IV−ve +ve Fibroblast (MES) Laminin −ve +ve Fibroblast (MES) BoneSialoprotein −ve +ve Osteoblast (MES) (BSP) Osteocalcin (OCN) −ve +veOsteoblast (MES) Nestin ND +ve Neural (ECT) Glial Fibrillary Acidic ND+ve Neural (ECT) Protein (GFAP) CBFA1 −ve +ve Osteoblast (MES) Osterix(OSX) ND +ve Osteoblast (MES) Osteocalcin (OCN) −ve +ve Osteoblast (MES)Sox9 ND +ve Chondrocyte (MES) Collagen X (COL X) +ve +ve Chondrocyte(MES) Leptin ND +ve Adipose (MES) GATA-4 ND +ve Cardiomyocyte (MES)Transferrin (TFN) ND +ve Hepatocyte (END) Flavin Containing ND +veHepatocyte (END) Monooxygenase (FCM)

TABLE 2 RT-PCR primers and conditions for the specific amplification ofhuman mRNA Target Sense/Antisene (5′-3′) Product Gene Primer SequencesSize GAPDH CACTGACACGTTGGCAGTGG/ [SEQ ID NO.7] 417 CATGGAGAAGGCTGGGGCTC[SEQ ID NO.8] Leptin ATGCATTGGGAACCCTGTGC/ [SEQ ID NO.9] 492GCACCCAGGGCTGAGGTCCA [SEQ ID NO.10] CBFA-1 GTGGACGAGGCAAGAGTTTCA/ [SEQID NO.11] 632 TGGCAGGTAGGTGTGGTAGTG [SEQ ID NO.12] OCNATGAGAGCCCTCACACTCCTC/ [SEQ ID NO.13] 289 CGTAGAAGCGCCGATAGGC [SEQ IDNO.14] GFAP CTGTTGCCAGAGATGGAGGTT/ [SEQ ID NO.15] 370TCATCGCTCAGGAGGTCCTT [SEQ ID NO.16] Nestin GGCAGCGTTGGAACAGAGGTTGGA/[SEQ ID NO.17] 460 CTCTAAACTGGAGTGGTCAGGGCT [SEQ ID NO.18] GATA-4GACTTCTCAGAAGGCAGAG/ [SEQ ID NO.19] 800 CTATCCTCCAAGTCCCAGAG [SEQ IDNO.20] PDGFB-R AATGTCTCCAGCACCTTCGT/ [SEQ ID NO.21] 650AGCGGATGTGGTAAGGCATA [SEQ ID NO.22] Osterix GGCACAAAGAAGCCGTACTC/ [SEQID NO.23] 247 CACTGGGCAGACAGTCAGAA [SEQ ID NO.24] COL XAGCCAGGGTTGCCAGGACCA/ [SEQ ID NO.25] 387 TTTTCCCACTCCAGGAGGGC [SEQ IDNO.26] SOX9 CTC TGC CTG TTT GGA CTT TGT/ [SEQ ID NO.27] 598 CCT TTG CTTGCC TTT TAC CTC [SEQ ID NO.28] Ang-1 CCAGTCAGAGGCAGTACATGCTA [SEQ IDNO.29] 300 AGAATTGAGTTA/ GTTTTCCATGGTTTTGTCCCGCAGTA [SEQ ID NO.30]

REFERENCES

-   1. Spradling et al., (2001). Nature 414(6859):98-104.-   2. Bianco and Robey (2001) Nature 414(6859):118-121.-   3. Fuchs and Segre (2000) Cell 100(1):143-55.-   4. Gronthos et al., (2000) Proc Natl Acad Sci USA 97(25):13625-30.-   5. Kuznetsov et al., (1997). J Bone Miner Res 12(9):133547.-   6. Bianco et al., (2001) Stem Cells 19(3):180-92.-   7. Lichtman (1981) Exp Hematol 9(4):391-410.-   8. Weiss (1976) Anatomical Record 106:161-84.-   9. Weiss and Sakai H (1984) Am J Anat 170(3):447-63.-   10. Dexter and Shadduck (1980) J Cell Physiol 102(3):279-86.-   11. Orchardson amd Cadden (2001) Dent Update 28(4):200-6, 208-9.-   12. Peters and Balling (1999) Trends Genet 15(2):59-65.-   13. Thesleff and Aberg (1999) Bone 25(1):123-5.-   14. Friedenstein et al., (1974) Transplantation 17(4):331-40.-   15. Castro-Malaspina et al., (1980) Blood 56(2):289-301.-   16. Weissman (2000) Cell 100(1):157-68.-   17. Uchida et al., (2000) Proc Natl Acad Sci USA 97(26):14720-5.-   18. Kuznetsov et al., (2001) J Cell Biol 153(5):1133-40.-   19. Shi et al. (2001) Bone 29(6):532-39.-   20. Pittenger et al., (1999) Science 284(5411):143-7.-   21. Gronthos et al., (2002) J Dent Res 81(8):531-5.-   22. Owen and Friedenstein (1988) Ciba Found Symp 136(29):42-60.-   23. Doherty et al., (1998) J Bone Miner Res 13(5):828-38.-   24. Bianco and Cossu (1999). Exp Cell Res 251(2):257-63.-   25. Gronthos et al., (1998) Isolation, purification and in vitro    manipulation of human bone marrow stromal precursor cells. In:    Beresford J N and Owen M E (ed) Marrow stromal cell culture.    Cambridge University Press, Cambridge, UK, pp 26-42.-   26. Gronthos and Simmons (1995) Blood 85(4):929-40.-   27. Gronthos et al., (1999) J Bone Miner Res 14(1):47-56.-   28. Filshie et al., (1998) Leukemia 12(3):414-21.-   29. Simmons and Torok-Storb (1991). Blood 78(1):55-62.-   30. Canfield and Schor (1998) Osteogenic potential of vascular    pericytes. In: Beresford J N and Owen M E (ed) Marrow stromal cell    culture. Cambridge University Press, Cambridge, UK, pp 128-148.-   31. Riminucci and Bianco (1998) The bone marrow stroma in vivo:    ontogeny, structure, cellular composition and changes in disease.    In: Beresford J N and Owen M E (ed) Marrow stromal cell culture.    Cambridge University Press, UK, Cambridge, UK, pp 10-25.-   32. Gronthos et al., (1994) Blood 84(12):4164-73.-   33. Oyajobi et al., (1999) J Bone Miner Res 14(3):351-61.-   34. Dennis et al., (2002). Cells Tissues Organs 170(2-3):73-82.-   35. Stewart et al., (1999) J Bone Miner Res 14(8):1345-56.-   36. Ahdjoudj et al., (2001) J Cell Biochem 81(1):23-38.-   37. Shih (1999) J Pathol 189(1):4-11.-   38. Van Vlasselaer et al., (1994) Blood 84(3):753-63.-   39. Prockop et al., (2001). Cytotherapy 3(5):393-6.-   40. Ducy et al., (1997) Cell 89(5):747-54.-   41. Komori et al., (1997) Cell 89(5):755-64.-   42. Woodbury et al., (2000) J Neurosci Res 61(4):364-70.-   43. Dey et al., (2001) Arch Oral Biol 46(3):249-60.-   44. Ueno et al., (2001) Matrix Biol 20(5-6):347-55.-   45. Couble et al., (2000) Calcif Tissue Int 66(2):129-38.-   46. Nehls and Drenckchahn (1993) Histochemistry 99(1):1-12.-   47. Schor et al., (1995) Clin Orthop 313:81-91.-   48. Pugach et al., (1999) Arkh Patol 61(4):18-21.-   49. Nehls et al., (1992) Cell Tissue Res 270(3):469-74.-   50. Brighton et al., (1992) Clin Orthop 275:287-99.-   51. Nayak et al., (1988) J Exp Med 167(3):1003-15.-   52. Andreeva et al., (1998) Tissue Cell 30(1):127-35.-   53. Cattoretti et al., (1993) Blood 81(7):1726-38.-   54. Charbord et al., (2000) J Hematother Stem Cell Res 9(6):935-43.-   55. Dennis and Charbord (2002) Stem Cells 20(3):205-14.-   56. Young et al., (2001) Anat Rec 263(4):350-60.-   Gronthos et al., (2003). Journal of Cell Science 116: 1827-1835.-   Pittenger et al., (1999). Science 284, 143-7.-   Simmons and Torok-Storb (1991a). Blood 78(1):55-62.-   Simmons and Torok-Storb (1991b). Blood 78:2848.-   Shi and Gronthos. (2003). Journal of Bone and Mineral Research,    18(4): 696-704.

The invention claimed is:
 1. A method of improving cardiac function in asubject suffering from a cardiovascular disease, the method comprisingadministering to the myocardium or coronary arteries of the subject apopulation of cells which has been enriched for mesenchymal precursorcells (MPCs) that express the markers STRO-1, CD146, and alpha-smoothmuscle actin and do not express CD34, CD45, and glycophorin-A.
 2. Themethod of claim 1, wherein the subject suffers from a cardiovasculardisease consisting of ischemic heart disease, coronary artery disease,acute myocardial infarction, congestive heart failure, cardiomyopathy,or angina.
 3. The method of claim 1, wherein the population of cellswhich has been enriched for MPCs that express the markers STRO-1, CD146,and alpha-smooth muscle actin and do not express CD34, CD45, andglycophorin-A comprises at least 1% MPCs capable of forming a clonogeniccolony.
 4. The method of claim 1, wherein the population of cells whichhas been enriched for MPCs that express the markers STRO-1, CD146, andalpha-smooth muscle actin and do not express CD34, CD45, andglycophorin-A comprises at least 1% STRO-1^(bright) MPCs.
 5. The methodof claim 1, wherein the population of cells which has been enriched forMPCs that express the markers STRO-1, CD146, and alpha-smooth muscleactin and do not express CD34, CD45, and glycophorin-A is isolated froma perivascular niche within a vascularised tissue source.
 6. The methodof claim 1, wherein the population of cells which has been enriched forMPCs that express the markers STRO-1, CD146, and alpha-smooth muscleactin and do not express CD34, CD45, and glycophorin-A is cultured orexpanded prior to administration.
 7. The method of claim 6, wherein thecultured or expanded population of cells comprises at least 1% MPCscapable of forming a clonogenic colony.
 8. The method of claim 6,wherein the cultured or expanded population of cells comprises at least1% STRO-1^(bright) MPCs.
 9. The method of claim 6, wherein the culturedor expanded population of cells comprises at least 10% STRO-1^(bright)MPCs.
 10. The method of claim 6, wherein the cultured or expandedpopulation of cells is administered by injection into the myocardium orclose to the myocardium.
 11. The method of claim 6, wherein the culturedor expanded population of cells is administered by injection into thecoronary arteries or close to the coronary arteries.
 12. The method ofclaim 1, wherein the population of cells which has been enriched forMPCs that express the markers STRO-1, CD146, and alpha-smooth muscleactin and do not express CD34, CD45, and glycophorin-A is introducedinto the body of the subject by localized injection or on a stent. 13.The method of claim 1, wherein the population of cells which has beenenriched for MPCs that express the markers STRO-1, CD146, andalpha-smooth muscle actin and do not express CD34, CD45, andglycophorin-A is administered by intracoronary catheter, or byintramyocardial, trans-epicardial or transendocardial injection.
 14. Themethod of claim 1, wherein the MPCs that express the markers STRO-1,CD146, and alpha-smooth muscle actin and do not express CD34, CD45, andglycophorin-A assemble into new blood vessel structures.
 15. The methodof claim 1, wherein the MPCs that express the markers STRO-1, CD146, andalpha-smooth muscle actin and do not express CD34, CD45, andglycophorin-A induce formation of new blood vessel structures.
 16. Themethod of claim 1, wherein the MPCs that express the markers STRO-1,CD146, and alpha-smooth muscle actin and do not express CD34, CD45, andglycophorin-A induce formation of new cardiomyocytes.
 17. The method ofclaim 1, wherein the MPCs that express the markers STRO-1, CD146, andalpha-smooth muscle actin and do not express CD34, CD45, andglycophorin-A induce proliferation of resident cardiomyocytes.
 18. Themethod of claim 6, wherein the cultured or expanded population of cellsis introduced into the body of the subject by localized injection,systemic injection, in a patch, or on a stent.
 19. The method of claim6, wherein the cultured or expanded population of cells is administeredby intracoronary catheter, or by intramyocardial, trans-epicardial ortransendocardial injection.
 20. The method of claim 6, wherein cells ofthe cultured or expanded population of cells assemble into new bloodvessel structures.
 21. The method of claim 6, wherein the cultured orexpanded population of cells induces formation of new blood vesselstructures.
 22. The method of claim 6, wherein the cultured or expandedMPCs that express the markers STRO-1, CD146, and alpha-smooth muscleactin and do not express CD34, CD45, and glycophorin-A induce formationof new cardiomyocytes.
 23. The method of claim 6, wherein the culturedor expanded MPCs that express the markers STRO-1, CD146, andalpha-smooth muscle actin and do not express CD34, CD45, andglycophorin-A induce proliferation of resident cardiomyocytes.
 24. Themethod of claim 1, wherein the cells are autologous.
 25. The method ofclaim 1, wherein the cells are from an allogeneic source.
 26. The methodof claim 1, wherein the population of cells which has been enriched forMPCs that express the markers STRO-1, CD146, and alpha-smooth muscleactin and do not express CD34, CD45, and glycophorin-A comprises atleast 0.01% MPCs capable of forming a clonogenic colony.
 27. The methodof claim 1, wherein the population of cells which has been enriched forMPCs that express the markers STRO-1, CD146, and alpha-smooth muscleactin and do not express CD34, CD45, and glycophorin-A comprises atleast 0.1% MPCs capable of forming a clonogenic colony.
 28. The methodof claim 1, wherein the population of cells which has been enriched forMPCs that express the markers STRO-1, CD146, and alpha-smooth muscleactin and do not express CD34, CD45, and glycophorin-A comprises atleast 0.01% STRO-1^(bright) MPCs.
 29. The method of claim 1, wherein thepopulation of cells which has been enriched for MPCs that express themarkers STRO-1, CD146, and alpha-smooth muscle actin and do not expressCD34, CD45, and glycophorin-A comprises at least 0.1% STRO-1^(bright)MPCs.
 30. The method of claim 1, wherein the population of cells whichhas been enriched for MPCs that express the markers STRO-1, CD146, andalpha-smooth muscle actin and do not express CD34, CD45, andglycophorin-A comprises at least 10% STRO-1^(bright) MPCs.
 31. Themethod of claim 1, further comprising seeding the population of cellswhich has been enriched for MPCs that express the markers STRO-1, CD146,and alpha-smooth muscle actin and do not express CD34, CD45, andglycophorin-A in a matrix prior to administration.
 32. The method ofclaim 31, wherein the matrix is a scaffold.
 33. The method of claim 32,wherein the scaffold induces differentiation of the population of cellswhich has been enriched for MPCs that express the markers STRO-1, CD146,and alpha-smooth muscle actin and do not express CD34, CD45, andglycophorin-A.
 34. The method of claim 1, further comprisingadministering to the subject a compound known to promote formation orrepair of blood vessels.
 35. The method of claim 34, wherein thepopulation of cells which has been enriched for MPCs that express themarkers STRO-1, CD146, and alpha-smooth muscle actin and do not expressCD34, CD45, and glycophorin-A and the compound known to promoteformation or repair of blood vessels are coadministered.